RESUMO
Our aims were to address three fundamental questions relating to the symptoms of community-acquired pneumonia (CAP): Do patients completely recover from pneumonia symptoms? How long does this recovery take? Which factors influence symptomatic recovery?We prospectively recruited patients at two hospitals in Liverpool, UK, into a longitudinal, observational cohort study and modelled symptom recovery from CAP. We excluded patients with cancer, immunosuppression or advanced dementia, and those who were intubated or palliated from admission. We derived a statistical model to describe symptom patterns.We recruited 169 (52% male) adults. Multivariable analysis demonstrated that the time taken to recover to baseline was determined by the initial severity of symptoms. Severity of symptoms was associated with comorbidity and was inversely related to age. The pattern of symptom recovery was exponential and most patients' symptoms returned to baseline by 10â days.These results will inform the advice given to patients regarding the resolution of their symptoms. The recovery model described here will facilitate the use of symptom recovery as an outcome measure in future clinical trials.
Assuntos
Infecções Comunitárias Adquiridas , Modelos Estatísticos , Pneumonia , Adulto , Idoso , Estudos de Coortes , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/fisiopatologia , Infecções Comunitárias Adquiridas/terapia , Comorbidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Gravidade do Paciente , Pneumonia/diagnóstico , Pneumonia/epidemiologia , Pneumonia/fisiopatologia , Pneumonia/terapia , Recuperação de Função Fisiológica , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos , Fatores de Tempo , Reino Unido/epidemiologiaRESUMO
BACKGROUND: Efferocytosis (the phagocytosis of apoptotic self cells) is a key mechanism in the resolution of inflammatory processes such as community-acquired pneumonia (CAP). Efferocytosis therefore represents a modifiable target for therapy aimed at enhancing intrinsic recovery mechanisms. It is currently not known which patients recovering from CAP would mostly benefit from a strategy aimed at enhancing efferocytosis. METHODS: We recruited a cohort of patients with CAP admitted to a hospital in Liverpool. One month into recovery, subjects were invited for research bronchoscopy and bronchoalveolar lavage. An ex vivo efferocytosis assay was performed by challenging alveolar macrophages with autologous, apoptotic neutrophils. The percentage of alveolar macrophages that had undergone efferocytosis was determined by flow cytometry. We conducted a multivariable regression using a linear mixed effects model to determine which clinical parameters were most closely associated with efferocytosis. RESULTS: We observed high rates of comorbidity among this CAP cohort. Efferocytosis was measured in 22 subjects. We assessed multiple combinations of clinical parameters for association with efferocytosis and found the best-fitting model included an interaction between smoking status and prior statin use-smoking being associated with decreased efferocytosis and statin use with increased efferocytosis. These effects were modified by an association between efferocytosis and body mass index (BMI), such that as BMI increased so did efferocytosis. CONCLUSIONS: This is the first study to measure efferocytosis in patients recovering from CAP. The results suggest that smokers with low BMI have impaired efferocytosis and may benefit from a statin to boost recovery.
Assuntos
Apoptose/fisiologia , Índice de Massa Corporal , Infecções Comunitárias Adquiridas/terapia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Fagocitose/fisiologia , Pneumonia/terapia , Fumar/efeitos adversos , Adulto , Idoso , Lavagem Broncoalveolar , Broncoscopia , Comorbidade , Inglaterra , Citometria de Fluxo , Humanos , Macrófagos Alveolares/fisiologia , Pessoa de Meia-Idade , Neutrófilos/fisiologiaRESUMO
Current diagnostic tests are ineffective for identifying the etiological pathogen in hospitalized adults with lower respiratory tract infections (LRTIs). The association of pneumococcal colonization with disease has been suggested as a means to increase the diagnostic precision. We compared the pneumococcal colonization rates and the densities of nasal pneumococcal colonization by (i) classical culture and (ii) quantitative real-time PCR (qPCR) targetinglytAin patients with LRTIs admitted to a hospital in the United Kingdom and control patients. A total of 826 patients were screened for inclusion in this prospective case-control study. Of these, 38 patients were recruited, 19 with confirmed LRTIs and 19 controls with other diagnoses. Nasal wash (NW) samples were collected at the time of recruitment. Pneumococcal colonization was detected in 1 patient with LRTI and 3 controls (P= 0.6) by classical culture. By qPCR, pneumococcal colonization was detected in 10 LRTI patients and 8 controls (P= 0.5). Antibiotic usage prior to sampling was significantly higher in the LRTI group than in the control group (19 versus 3;P< 0.001). With a clinically relevant cutoff of >8,000 copies/ml on qPCR, pneumococcal colonization was found in 3 LRTI patients and 4 controls (P> 0.05). We conclude that neither the prevalence nor the density of nasal pneumococcal colonization (by culture and qPCR) can be used as a method of microbiological diagnosis in hospitalized adults with LRTI in the United Kingdom. A community-based study recruiting patients prior to antibiotic therapy may be a useful future step.
Assuntos
Técnicas Bacteriológicas/métodos , Portador Sadio/diagnóstico , Mucosa Nasal/microbiologia , Infecções Pneumocócicas/diagnóstico , Pneumonia/diagnóstico , Reação em Cadeia da Polimerase em Tempo Real/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Portador Sadio/epidemiologia , Estudos de Casos e Controles , Feminino , Hospitalização , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Pneumocócicas/epidemiologia , Estudos Prospectivos , Reino UnidoRESUMO
The vaccination planning tool for avian influenza supports evidence-based planning and preparedness for vaccinating poultry at national and regional levels. This study describes the development, testing, and application of a vaccination planning tool for H5N1 highly pathogenic avian influenza (HPAI) used in two South Asian countries. The tool consists of eight planning clusters, 37 planning elements, and 303 referenced planning criteria. Both countries attained a score of 52% among planning clusters as a measure of preparedness. The highest and lowest planning cluster scores included vaccination strategies and financial readiness, respectively. The comprehensive vaccination program was identified as the most-useful planning cluster for assessing preparedness, and 86% of participants indicated that the objectives of the planning tool were achieved. Based on these results, the planning tool provides a structured approach for decision makers to develop their national vaccination program for HPAI as part of an overall strategy for the progressive reduction and control of endemic influenza viruses in poultry.
Assuntos
Virus da Influenza A Subtipo H5N1/fisiologia , Influenza Aviária/prevenção & controle , Doenças das Aves Domésticas/prevenção & controle , Vacinação/métodos , Animais , Tomada de Decisões , Planejamento em Saúde , Virus da Influenza A Subtipo H5N1/imunologia , Influenza Aviária/virologia , Aves Domésticas , Doenças das Aves Domésticas/imunologia , Doenças das Aves Domésticas/virologia , Vacinação/instrumentação , Vacinas Virais/administração & dosagem , Vacinas Virais/imunologiaRESUMO
We describe an active and latent tuberculosis (TB) screening programme undertaken in Manchester, UK in response to the arrival of a cohort of refugees from Afghanistan. In total, 217 adults and 347 children were offered screening, which involved a symptom questionnaire, Mantoux test or interferon gamma release assay, blood-borne virus screening and a chest X-ray in participants over the age of 11. We found a latent TB infection (LTBI) rate of 15% in adults and 1.5% in children, which is lower than global LTBI estimates. One case of active TB was detected. Screening was undertaken in the hotels where participants were temporarily housed, leading to high participant engagement levels. Attendance rates were almost doubled compared with a previous hospital-based screening programme. Hotel-based screening for TB presented several challenges, including transfer of information and results to secondary care. Understanding these challenges and learning from the programme has helped us refine our screening protocol to optimise migrant TB screening in Manchester in the future.
Assuntos
Tuberculose Latente , Tuberculose , Criança , Adulto , Humanos , Tuberculose Latente/diagnóstico , Tuberculose Latente/epidemiologia , Afeganistão , Estudos de Viabilidade , Tuberculose/diagnóstico , Testes de Liberação de Interferon-gama/métodos , Programas de RastreamentoRESUMO
BACKGROUND: Gastrointestinal bleeding is a cause of anaemia in dogs. A reliable, non-invasive biomarker to differentiate gastrointestinal bleeding from other causes of anaemia would be advantageous to direct clinical decisions in anaemic patients. Plasma urea:creatinine ratio is an accepted biomarker of upper gastrointestinal bleeding in human medicine. OBJECTIVES: The objective of this study was to evaluate plasma urea:creatinine ratio as a biomarker of gastrointestinal bleeding in a population of dogs with anaemia. METHODS: This was a prospective cross-sectional study of dogs with anaemia presenting to referral centres for the investigation of anaemia. Cases were categorised as having overt gastrointestinal bleeding (melena on presentation), occult gastrointestinal bleeding (historical and diagnostic findings consistent with gastrointestinal bleeding without melena at presentation) or anaemia of other cause (confident diagnosis other than gastrointestinal bleeding reached, normal diagnostic imaging of gastrointestinal tract). Urea:creatinine ratio at presentation was calculated by dividing urea (mg/dL) by creatinine (mg/dL). RESULTS: Ninety-five dogs were included. Plasma urea:creatinine ratio was not significantly different between dogs with overt or occult gastrointestinal bleeding or those with anaemia of other cause (median urea:creatinine ratio 25.8, 20.7 and 22.5, respectively). No significant difference in urea:creatinine ratio was found between dogs with upper and lower gastrointestinal bleeding (median urea:creatinine ratio 19.4 and 24.6, respectively). CONCLUSIONS: Plasma urea:creatinine ratio was not helpful in differentiating between dogs with anaemia resulting from gastrointestinal bleeding (overt or occult) and those with other causes of anaemia.
Assuntos
Anemia , Doenças do Cão , Humanos , Cães , Animais , Melena/complicações , Melena/veterinária , Creatinina , Estudos Prospectivos , Estudos Transversais , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/veterinária , Ureia , Anemia/diagnóstico , Anemia/veterinária , Anemia/complicações , Biomarcadores , Doenças do Cão/diagnósticoRESUMO
OBJECTIVES: Feline infectious peritonitis (FIP) is a serious disease that arises due to feline coronavirus infection. The nucleoside analogues remdesivir and GS-441524 can be effective in its treatment, but most studies have used unregulated products of unknown composition. The aim of the present study was to describe the treatment of FIP using legally sourced veterinary-prescribed regulated veterinary compounded products containing known amounts of remdesivir (injectable) or GS-441524 (oral tablets). METHODS: Cats were recruited via email advice services, product sales contacts and study publicity. Cats were excluded if they were deemed unlikely to have FIP, were not treated exclusively with the veterinary compounded products, or if there was a lack of cat and/or treatment (including response) data. Extensive cat and treatment data were collected. RESULTS: Among the 307 cats recruited, the predominant type of FIP was most commonly abdominal effusive (49.5%) and then neurological (14.3%). Three treatment protocols were used; remdesivir alone (33.9%), remdesivir followed by GS-441524 (55.7%) and GS-441524 alone (10.4%). The median (range) initial treatment period duration and longest follow-up time point after starting treatment were 84 (1-330) days and 248 (1-814) days, respectively. The most common side effect was injection pain (in 47.8% of those given subcutaneous remdesivir). Of the 307 cats, 33 (10.8%) relapsed, 15 (45.5%) during and 18 (54.5%) after the initial treatment period. At the longest follow-up time point after completion of the initial treatment period, 84.4% of cats were alive. The cats achieving a complete response within 30 days of starting treatment were significantly more likely to be alive at the end of the initial treatment period than those cats that did not. CONCLUSIONS AND RELEVANCE: Legally sourced remdesivir and GS-441524 products, either alone or used sequentially, were very effective in the treatment of FIP in this group of cats. Variable protocols precluded statistical comparison of treatment regimens.
Assuntos
Doenças do Gato , Infecções por Coronavirus , Peritonite Infecciosa Felina , Gatos , Animais , Estudos Retrospectivos , Peritonite Infecciosa Felina/tratamento farmacológico , Infecções por Coronavirus/veterinária , Doenças do Gato/tratamento farmacológicoRESUMO
Bronchiectasis is a heterogeneous and increasingly prevalent chronic pulmonary disease that is associated with significant morbidity. In this review, we outline how patients with bronchiectasis may present clinically and describe an approach to its diagnosis, including how to identify an underlying aetiology. We discuss the important considerations when treating either acute exacerbations or stable disease and provide an overview of the role of long-term antimicrobials, airway clearance methods and other supportive management.
Assuntos
Antibacterianos , Bronquiectasia , Antibacterianos/uso terapêutico , Bronquiectasia/diagnóstico , Bronquiectasia/etiologia , Bronquiectasia/terapia , HumanosRESUMO
A 60-year-old man with swab-positive COVID-19 and extensive ground-glass change seen on CT imaging was successfully managed on our COVID-19 high-dependency unit with only low-flow oxygen and strict awake proning instructions. He was successfully weaned off oxygen entirely without any requirement for non-invasive or invasive ventilation and made a recovery to be discharged home after an 18-day hospital stay.
Assuntos
Infecções por Coronavirus , Enoxaparina/administração & dosagem , Hipóxia , Oxigenoterapia/métodos , Pandemias , Pneumonia Viral , Decúbito Ventral , Anticoagulantes/administração & dosagem , Betacoronavirus/isolamento & purificação , COVID-19 , Quimioprevenção/métodos , Angiografia por Tomografia Computadorizada/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Dispneia/diagnóstico , Dispneia/etiologia , Ecocardiografia/métodos , Humanos , Hipóxia/diagnóstico , Hipóxia/etiologia , Hipóxia/terapia , Unidades de Terapia Intensiva , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Embolia Pulmonar/prevenção & controle , SARS-CoV-2 , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
The demographics and comorbidities of patients with community acquired pneumonia (CAP) vary enormously but stratified treatment is difficult because aetiological studies have failed to comprehensively identify the pathogens. Our aim was to describe the bacterial microbiota of CAP and relate these to clinical characteristics in order to inform future trials of treatment stratified by co-morbidity. CAP patients were prospectively recruited at two UK hospitals. We used 16S rRNA gene sequencing to identify the dominant bacteria in sputum and compositional data analysis to determine associations with patient characteristics. We analysed sputum samples from 77 patients and found a Streptococcus sp. and a Haemophilus sp. were the most relatively abundant pathogens. The Haemophilus sp. was more likely to be dominant in patients with pre-existing lung disease, and its relative abundance was associated with qPCR levels of Haemophilus influenzae. The most abundant Streptococcus sp. was associated with qPCR levels of Streptococcus pneumoniae but dominance could not be predicted from clinical characteristics. These data suggest chronic lung disease influences the microbiota of sputum in patients with CAP. This finding could inform a trial of stratifying empirical CAP antibiotics to target Haemophilus spp. in addition to Streptococcus spp. in those with chronic lung disease.
Assuntos
Doença Crônica , Infecções Comunitárias Adquiridas , Pneumonia Associada a Assistência à Saúde , Pneumopatias , Pulmão/microbiologia , Escarro/microbiologia , Idoso , Doença Crônica/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Haemophilus influenzae/genética , Haemophilus influenzae/isolamento & purificação , Pneumonia Associada a Assistência à Saúde/epidemiologia , Humanos , Pneumopatias/epidemiologia , Pneumopatias/microbiologia , Masculino , Microbiota/genética , Pessoa de Meia-Idade , RNA Ribossômico 16S/genética , Streptococcus pneumoniae/genética , Streptococcus pneumoniae/isolamento & purificação , Reino UnidoRESUMO
A qualitative study was undertaken to attempt to understand reasons for the delayed diagnosis of tuberculosis (TB) amongst Ugandan women and to describe the nature of TB stigma and its effects in Uganda. Twelve women were interviewed. Participants were selected on the basis that they had smear-positive TB and had delayed consulting healthcare services for ≥30 days. Semi-structured interviews were conducted and analysed using thematic content analysis. The study showed that the main reason for delayed diagnosis amongst women interviewed was a lack of recognition of symptoms. This may be due to low levels of TB awareness in the community. The study also showed that TB is stigmatised in Uganda, mainly due to associations with HIV. Many participants believed that TB only exists with HIV and that TB causes HIV tests to appear negative even for HIV-infected people. Health education programmes would be helpful to improve the understanding of TB and to combat harmful beliefs about TB and HIV in the community.