Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 14 de 14
Filtrar
1.
Infection ; 49(3): 533-537, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33774804

RESUMO

To determine the most relevant pathogens for CAP in Germany, patients with radiologically confirmed pulmonary infiltrates and at least one clinical sign of lung infection were prospectively recruited within the CAPNETZ cohort from 2004 until 2016. In 990 out of 4.672 patients (21%) receiving complete diagnostics the most prominent change of pathogens was a decrease of S. pneumoniae (58% in 2004 to 37.5% in 2016; p ≤ 0.001, ρ = - 0.148) and an increase of H. influenzae (12.2% to 20.8%; p = 0.001, ρ = 0.104).


Assuntos
Infecções Comunitárias Adquiridas , Pneumonia Bacteriana , Bactérias , Infecções Comunitárias Adquiridas/epidemiologia , Haemophilus influenzae , Humanos , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/epidemiologia , Streptococcus pneumoniae
3.
Pneumologie ; 73(10): 605-616, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31622999

RESUMO

Pneumonia belongs to the most frequent and most deadly infectious diseases worldwide. It represents an increasing problem for the aging population. The incidence and mortality rises with every decade. The clinical presentation of pneumonia differs between elderly and younger patients. Multiple factors including functional status (self-dependency and immobilization), comorbidities, immunosenescence, nutritional status, swallowing disorders have to be accounted for. Pneumonia in the elderly has to be differentiated from nursing home acquired pneumonia. Diagnosis of pneumonia of the elderly demands special attention as the diagnostic value of common biomarkers and prognostic scores is different.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Pneumonia/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/diagnóstico , Comorbidade , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Estado Nutricional , Pneumonia/diagnóstico
4.
Internist (Berl) ; 60(11): 1151-1154, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31463521

RESUMO

Human rhinoviruses (RV) belong to the Picornaviridae and are divided into three species: rhinovirus A, B and C. As causative viruses of upper airway infections (common cold), they possess enormous epidemiological and clinical importance. Furthermore, rhinoviruses are significant pathogens of acute exacerbations of chronic airway diseases such as asthma and chronic obstructive pulmonary disease. Their role as a cofactor in the development of pneumonia and their relevance in critically ill patients is still unclear and the focus of current research. Due to the unspecific clinical symptoms, diagnosis is difficult. Laboratory detection is sophisticated and a distinction between clinically relevant infection and contamination not always possible. Specific therapeutic antiviral strategies against rhinovirus infection do not exist as yet and, due to the large variety of subtypes, the development of vaccines remains a considerable challenge.


Assuntos
Asma/complicações , Infecções por Picornaviridae/complicações , Pneumonia/complicações , Doença Pulmonar Obstrutiva Crônica/complicações , Rinite/complicações , Rhinovirus/isolamento & purificação , Antivirais , Asma/diagnóstico , Asma/virologia , Progressão da Doença , Humanos , Infecções por Picornaviridae/diagnóstico , Infecções por Picornaviridae/virologia , Pneumonia/diagnóstico , Pneumonia/virologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/virologia , Infecções Respiratórias , Rinite/diagnóstico , Rinite/virologia
5.
Internist (Berl) ; 58(11): 1142-1149, 2017 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-28983645

RESUMO

Chronic Pseudomonas aeruginosa colonization in the airways of patients with chronic obstructive pulmonary disease (COPD) is probably associated with increased mortality and morbidity and a faster progress of COPD, although this has not been conclusively proven by studies. Studies demonstrating an improvement in prognosis in COPD patients by early eradication of Pseudomonas or at least a reduction of the bacterial burden by either inhaled or oral antibiotic maintenance therapy, are missing. An impact on the exacerbation rate has only been shown for macrolide maintenance treatment; however, this effect could be explained by the inclusion of patients with bronchiectasis in the studies. This is a group of patients for whom the effect of this kind of antibiotic treatment is well known. Further studies on the prevention and treatment of chronic Pseudomonas colonization in COPD patients are urgently needed. The stability of the respiratory microbiome probably plays an essential role in the course of the disease and should be established as a study endpoint.


Assuntos
Antibacterianos/uso terapêutico , Macrolídeos/uso terapêutico , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa/patogenicidade , Doença Pulmonar Obstrutiva Crônica/microbiologia , Administração por Inalação , Administração Oral , Bronquiectasia/tratamento farmacológico , Bronquiectasia/microbiologia , Bronquiectasia/mortalidade , Progressão da Doença , Humanos , Assistência de Longa Duração , Infecções por Pseudomonas/mortalidade , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/mortalidade , Taxa de Sobrevida , Virulência
6.
Int J Tuberc Lung Dis ; 21(2): 236-243, 2017 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-28234091

RESUMO

BACKGROUND: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality, and chronic obstructive pulmonary disease (COPD) is a frequent comorbidity. The bacterial aetiology of CAP-COPD and its possible associations with serum markers and mortality are incompletely understood. OBJECTIVES: 1) To assess the bacterial aetiology of CAP only and CAP-COPD, and 2) to study the association between bacterial aetiology, empirical antibiotic treatment, serum markers and mortality. METHODS: Of 1288 patients with CAP (57.0% males, age 59.0 years ± 18.5), 262 (20.3%) fulfilled the diagnostic criteria for COPD. Differences between subgroups were investigated using univariate analyses and corrected for multiple comparisons. RESULTS: Streptococcus pneumoniae was the most common pathogen (30.8% CAP only vs. 26.0% CAP-COPD, not significant). Haemophilus influenzae was significantly more frequent in CAP-COPD (5.6% CAP only vs. 26.0% CAP-COPD, P < 0.001). The number given adequate empirical antibiotic treatment was comparable (83.3% CAP only vs. 83.6% CAP-COPD, P > 0.05). The CAP-COPD group had worse CURB-65 and partial pressure of arterial oxygen levels than the CAP only group (P < 0.001). Partial pressure of arterial carbon dioxide levels were increased in CAP-COPD patients without pathogen detection (P < 0.001). Short- (P = 0.011) and long-term mortality (P = 0.006) were highest in CAP-COPD without pathogen detection. CONCLUSION: It is important to identify COPD patients with CAP. In particular, those without bacterial pathogen detection have more severe CAP and are at higher risk of dying. Better understanding of the aetiology could contribute to improved management and treatment of CAP in COPD patients.


Assuntos
Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/epidemiologia , Pneumonia Bacteriana/epidemiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Adulto , Bactérias/isolamento & purificação , Biomarcadores/sangue , Dióxido de Carbono/sangue , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/mortalidade , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/microbiologia , Pneumonia Bacteriana/mortalidade , Doença Pulmonar Obstrutiva Crônica/mortalidade
7.
Respir Med ; 109(1): 137-45, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25464905

RESUMO

BACKGROUND: Infections with non-tuberculous mycobacteria (NTM) represent an increasing problem. Their clinical relevance is still largely unknown as well as predictors for mortality in affected patients. The objective was to describe prevalence and clinical relevance of different NTM and to identify risk factors for mortality. METHODS: Retrospective cohort study of 124 patients with NTM detection between January 2001 and December 2011. Clinical characteristics like symptoms and radiological appearance were assessed at presentation. The primary outcome was all cause mortality during the follow-up period. Univariate and multivariate survival analyses using Cox proportional hazard models were employed for statistical analysis. RESULTS: Over the study period, the frequency of NTM isolation varied from 4 to 12 patients per year. Twenty-nine out of 124 patients (23%) had a clinically relevant infection, according to the criteria of the American Thoracic Society (ATS). Mycobacterium avium was isolated most frequently, but Mycobacterium kansasii, Mycobacterium malmoense and Mycobacterium xenopi had the highest clinical relevance. Symptoms were mostly diverse and non-specific. On radiology, cavities were observed more frequently than a nodular-bronchiectatic variant or consolidation. In 75% of all patients, follow up time was more than two years. Median survival was 6.5 years (95%CI = 2.7-10.3). Factors significantly influencing survival time were haemoptysis (HR = 0.2, 95%CI = 0.1-0.6) and a consolidation on imaging (HR = 5.1, 95%CI 1.4-18.2). CONCLUSIONS: The presentation of an infection with NTM can be diverse and depends mainly on the causative NTM pathogen. The most important predictor for increased mortality is the radiological appearance of a consolidation.


Assuntos
Pneumopatias/mortalidade , Infecções por Mycobacterium não Tuberculosas/mortalidade , Infecções Respiratórias/mortalidade , Adulto , Idoso , Antibacterianos/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Pneumopatias/diagnóstico por imagem , Pneumopatias/tratamento farmacológico , Pneumopatias/microbiologia , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/diagnóstico por imagem , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/microbiologia , Mycobacterium avium/isolamento & purificação , Mycobacterium kansasii/isolamento & purificação , Países Baixos/epidemiologia , Prognóstico , Infecções Respiratórias/diagnóstico por imagem , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/microbiologia , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Tomografia Computadorizada por Raios X
8.
J Clin Virol ; 61(2): 181-8, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25066886

RESUMO

BACKGROUND: Despite the increasing knowledge on the role of viruses in exacerbations of COPD (AECOPD), it is less clear which viruses are involved and to what extent they contribute to exacerbations. This review aims to systematically combine and evaluate the available literature of the prevalence of respiratory viruses in patients with AECOPD, detected by PCR. METHODS: An electronic search strategy was performed on PubMed and Embase and reference lists were screened for eligible studies. Cross-sectional, prospective studies and case-control studies were included. The primary outcome measure was the prevalence of respiratory viruses (adenovirus, bocavirus, coronavirus, EBV, hMPV, influenza, parainfluenza, rhino-/enterovirus, RSV) in respiratory secretions of patients during an AECOPD. Secondary outcomes were the odds of the presence of the viruses in different respiratory secretions and the odds of the presence of viruses in upper and lower respiratory tract (URT/LRT) samples. RESULTS: Nineteen studies with 1728 patients were included. Rhino-/enteroviruses (16.39%), RSV (9.90%) and influenza (7.83%) were the most prevalent viruses detected with lower detection rates of coronaviruses (4.08%) and parainfluenza (3.35%). Adenovirus (2.07%), hMPV (2.78%) and bocaviruses (0.56%) appear to be rare causative agents of AECOPD. Definitive conclusions regarding the role of EBV cannot be made. Seven of the eight analyzed viruses had a higher prevalence in LRT samples. Coronaviruses were detected more frequently in the URT. CONCLUSIONS: Respiratory viruses are frequently detected in both URT and LRT samples in AECOPD with rhino-/enteroviruses, RSV and influenza viruses the most prevalent viruses. Detection rates vary between the two sites for different viruses.


Assuntos
Doença Pulmonar Obstrutiva Crônica/patologia , Doença Pulmonar Obstrutiva Crônica/virologia , Infecções Respiratórias/complicações , Infecções Respiratórias/virologia , Viroses/complicações , Viroses/virologia , Vírus/isolamento & purificação , Secreções Corporais/virologia , Humanos , Reação em Cadeia da Polimerase , Prevalência , Sistema Respiratório/virologia , Infecções Respiratórias/epidemiologia , Viroses/epidemiologia , Vírus/classificação , Vírus/genética
9.
Clin Microbiol Infect ; 20 Suppl 5: 45-51, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24313448

RESUMO

To overview the present global burden of pneumococcal disease is important because new preventive measures such as the pneumococcal conjugate vaccine 13 are currently being evaluated. Pneumococcal disease is roughly divided into non-invasive and invasive disease. The burden of non-invasive pneumococcal disease in adults is mainly determined by community-acquired pneumonia. Pneumococcal pneumonia has high incidence rates and carries a high mortality risk, especially in the elderly. Within the cluster of invasive pneumococcal diseases, pneumonia also represents the most common infectious source. Incidence and mortality rates of both non-invasive and invasive disease have changed as a result of pneumococcal vaccination in children. However, especially elderly patients with comorbidities remain vulnerable to morbidity and mortality caused by pneumococcal disease. The current review summarizes the current knowledge on the epidemiology including outcome of the main clinical forms of pneumococcal disease, with a special focus on elderly patients. Furthermore, the economic burden and future vaccine strategies are briefly discussed.


Assuntos
Infecções Comunitárias Adquiridas/economia , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Pneumocócicas/economia , Infecções Pneumocócicas/epidemiologia , Adulto , Comorbidade , Humanos , Incidência , Vacinas Pneumocócicas/uso terapêutico , Streptococcus pneumoniae , Vacinação , Vacinas Conjugadas/uso terapêutico
10.
Respiration ; 85(1): 15-26, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23037178

RESUMO

BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) are related to high mortality, especially in hospitalized patients. Predictors for severe outcomes are still not sufficiently defined. OBJECTIVES: To assess the mortality rate and identify potential determinants of mortality in a cohort of patients hospitalized for AE-COPD. METHODS: A retrospective, observational cohort study including all consecutive patients admitted between January 1, 2009, and April 1, 2010, for AE-COPD. Potential predictors were assessed at initial presentation at the emergency room. The primary outcome was mortality during 1-year follow-up. Univariate and multivariate time-to-event analyses using Cox proportional hazard models were employed for statistical analysis. RESULTS: A total of 260 patients were enrolled in this study. Mean age was 70.5 ± 10.8 years, 50.0% were male and 63.4% had severe COPD. The in-hospital mortality rate was 5.8% and the 1-year mortality rate was 27.7%. Independent risk factors for mortality were age [hazard ratio (HR) = 1.04; 95% confidence interval (CI) = 1.01-1.07], male sex (HR = 2.00; 95% CI = 1.15-3.48), prior hospitalization for AE-COPD in the last 2 years (HR = 2.56; 95% CI = 1.52-4.30), prior recorded congestive heart failure (HR = 1.75; 95% CI = 1.03-2.97), PaCO2 ≥6.0 kPa (HR = 2.90; 95% CI = 1.65-5.09) and urea ≥8.0 mmol/l (HR = 2.38; 95% CI = 1.42-3.99) at admission. CONCLUSIONS: Age, male sex, prior hospitalization for AE-COPD in the last 2 years, prior recorded congestive heart failure, hypercapnia and elevated levels of urea at hospital admission are independent predictors of mortality within the first year after admission.


Assuntos
Hospitalização/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/terapia , Idoso , Intervalos de Confiança , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Masculino , Países Baixos/epidemiologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
11.
Pneumologe (Berl) ; 10(5): 326-334, 2013.
Artigo em Alemão | MEDLINE | ID: mdl-32214958

RESUMO

While acute viral respiratory tract infections are one of the major reasons for the loss of productivity among the general population in industrialized nations, they are one of the top killers among infants worldwide, in particular in low-income countries. With the advances in molecular diagnostics and the introduction of high-throughput screening techniques a variety of novel, so far unknown viruses have been discovered from respiratory secretions. However, the clinical significance is often difficult to determine. This review article provides an introduction to those novel viruses which have been described since the beginning of the millennium and discusses the clinical relevance in the light of current scientific evidence. The viruses covered by the present review are human metapneumovirus, human bocavirus, human coronaviruses OC43, 229E, NL63, HKU1, SARS and MERS, human polyomaviruses KI, MC and WU and human parechoviruses.

12.
Internist (Berl) ; 52(9): 1047-52, 2011 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-21809066

RESUMO

Influenza infections have important socio-economic consequences. Risk groups identified so far include small children and elderly adults with comorbidities. In recent years in addition to seasonal influenza an outbreak of avian influenza occurred in 2005 and the new H1N1 pandemic occurred in 2009. For the latter other at risk groups were affected and a different clinical course has been documented. The focus of this article is to give an overview on the epidemiology, clinical characteristics, diagnosis and therapy of influenza infections.


Assuntos
Influenza Humana/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Infecções Oportunistas Relacionadas com a AIDS/terapia , Adamantano/uso terapêutico , Adulto , Fatores Etários , Idoso , Antivirais/uso terapêutico , Criança , Pré-Escolar , Feminino , Alemanha , Humanos , Lactente , Vírus da Influenza A Subtipo H1N1 , Vacinas contra Influenza/administração & dosagem , Influenza Humana/mortalidade , Influenza Humana/terapia , Masculino , Neuraminidase/antagonistas & inibidores , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Vigilância da População , Gravidez , Rimantadina/uso terapêutico , Taxa de Sobrevida
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA