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1.
Medicine (Baltimore) ; 99(2): e18504, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914021

RESUMEN

We aimed to evaluate the clinical significance of bacterial coexistence and the coinfection dynamics between bacteria and respiratory viruses among young children. We retrospectively analyzed clinical data from children aged < 5 years hospitalized with a community-acquired single respiratory viral infection of influenza, adenovirus, or RSV during 2 recent consecutive influenza seasons. Remnant respiratory specimens were used for bacterial PCR targeting Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus.A total of 102 children were included; median age was 0.8 years and 44.1% had underlying comorbidities. Overall, 6.8% (7/102) of cases were classified as severe diseases requiring intensive care unit admission and/or mechanical ventilation and ranged from 8.8% for a patient with RSV and 7.6% for those with adenovirus to 0% for those with influenza viruses. The overall viral-bacterial codetection rate was 59.8% (61/102); M catarrhalis was the most frequent (33.3%), followed by H influenzae (31.4%). Influenza cases showed higher bacterial codetection rates (80.0%; 8/10) compared with those with adenoviruses (69.2%; 9/13) and RSV (55.7%; 44/79). S pneumoniae and H influenzae codetections were associated with reduced severity (aOR, 0.24; 95% CI, 0.07-0.89), and reduced risk of wheezing (aOR, 0.36; 95% CI, 0.13-0.98), respectively.We observed the interactions between respiratory viruses and bacteria and the clinical significance of viral-bacterial coexistence in upper airway on disease severity. Future study will be necessary to elucidate the active interactions between different viruses and bacteria and give clues to risk stratified strategy in the management of respiratory infections among young children.


Asunto(s)
Adenoviridae/aislamiento & purificación , Haemophilus influenzae/aislamiento & purificación , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/virología , Infecciones por Adenoviridae/diagnóstico , Infecciones por Adenoviridae/virología , Bacterias/genética , Preescolar , Coinfección/microbiología , Coinfección/virología , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/virología , Femenino , Hospitalización , Humanos , Lactante , Recién Nacido , Gripe Humana/diagnóstico , Gripe Humana/virología , Masculino , Prevalencia , Ruidos Respiratorios/diagnóstico , Ruidos Respiratorios/etiología , Infecciones por Virus Sincitial Respiratorio/diagnóstico , Infecciones por Virus Sincitial Respiratorio/virología , Virus Sincitiales Respiratorios/genética , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/epidemiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Staphylococcus aureus/aislamiento & purificación , Streptococcus pneumoniae/aislamiento & purificación , Virus/genética
2.
Clin Biochem ; 75: 30-34, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31672649

RESUMEN

OBJECTIVES: The aim of this study was to explore the auxiliary diagnostic value of neutrophil gelatinase-associated lipocalin (NGAL) and anti-citrullinated alpha-enolase peptide 1 (CEP-1) in lower respiratory tract infections (LRTIs). METHODS: Blood samples were collected from 99 in-patients with LRTIs [62 community-acquired pneumonia (CAP), 14 acute exacerbated chronic obstructive pulmonary diseases (AECOPD), 23 other diseases] and 50 healthy subjects. NGAL, CEP-1 and IL-6 were measured and compared. IL-6 was tested by electrochemiluminescence assay kit on Roche E601 immunology analyzer, CEP-1 was assessed with enzyme-linked immunosorbent assay kit, and NGAL was detected by latex immunoturbidimetric assay kit on Beckman Coulter AU2700. RESULTS: Compared with healthy controls, NGAL and IL-6 levels were significantly increased in the patients with LRTIs, the area under the curves (AUC) was 0.97 and 0.88 respectively (P < 0.01). The sensitivity and specificity of NGAL at a cut-off of 86 ng/ml were 93.0% and 96.0%, respectively, in which the sensitivity was consistent with IL-6 (P = 0.21) and the specificity was better than IL-6 (P < 0.01). CEP-1 slightly increases in the patient group, however the difference was not significant (P = 0.41). The levels of NGAL and IL-6 was no differences in different diseases, the P-value was 0.50 and 0.29, respectively. LRTIs with and without underlying diseases have similar NGAL and IL-6 values. CONCLUSIONS: NGAL, rather than CEP-1, may be appealing adjuncts for diagnosis of LRTIs. NGAL proved to be a better biomarker than IL-6.


Asunto(s)
Interleucina-6/sangre , Lipocalina 2/sangre , Infecciones del Sistema Respiratorio , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infecciones del Sistema Respiratorio/sangre , Infecciones del Sistema Respiratorio/diagnóstico
3.
Ann Otol Rhinol Laryngol ; 129(1): 82-86, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31522522

RESUMEN

OBJECTIVE: The identification of rare sources of laryngeal infection in immunocompetent patients. Recovered organisms were Mycobacterium tuberculosis (laryngeal tuberculosis [LTB]), Mycobacterium fortuitum (laryngeal Mycobacterium fortuitum [LMF]), and Blastomyces dermatiditis (laryngeal blastomycosis [LB]). METHOD: Single institution retrospective case series of three patients over a 2.5-year period and review of the literature on laryngeal infections by three atypical organisms. RESULTS: Three patients presented with hoarseness and cough; one additionally had throat pain (LTB). Indirect laryngoscopy demonstrated diffuse laryngeal ulceration (LTB, LMF) and an exophytic, contiguous glottic mass (LB). Direct microlaryngoscopic biopsies and cultures established the diagnoses, including a frozen section in one case (LB), which prevented a simultaneously planned surgical resection. Appropriate antimicrobial therapy yielded dramatic laryngeal and corresponding vocal improvement, for which we provide unique photo and audio documentation. In the last 10 years, fewer than 500 cases of LTB have been reported in the English language medical literature, principally outside the United States. To date, there have been reports of only 34 LB and no cases of LMF. CONCLUSION: Atypical infections of the larynx may be localized and mimic laryngeal cancer on endoscopy. Tissue examination as well as microbiologic samples are diagnostic and complementary.


Asunto(s)
Blastomicosis/diagnóstico , Neoplasias Laríngeas/diagnóstico , Laringoscopía , Infecciones por Micobacterias no Tuberculosas/diagnóstico , Tuberculosis Laríngea/diagnóstico , Adulto , Biopsia , Blastomyces , Blastomicosis/complicaciones , Blastomicosis/patología , Tos/etiología , Técnicas de Cultivo , Diagnóstico Diferencial , Femenino , Ronquera/etiología , Humanos , Masculino , Persona de Mediana Edad , Infecciones por Micobacterias no Tuberculosas/complicaciones , Infecciones por Micobacterias no Tuberculosas/patología , Mycobacterium fortuitum , Infecciones del Sistema Respiratorio/complicaciones , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/patología , Tuberculosis Laríngea/complicaciones , Tuberculosis Laríngea/patología
4.
BMC Infect Dis ; 19(1): 975, 2019 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-31747887

RESUMEN

BACKGROUND: The current evidence of extra length of stay (LOS) attributable to healthcare-associated infection (HCAI) scarcely takes time-dependent bias into consideration. Plus, limited evidences were from developing countries. We aim to estimate the extra LOS and risk factors of mortality attributable to HCAI for inpatients. METHODS: Multi-state model (MSM) was adopted to estimate the extra LOS attributable to HCAI of each type and subgroup. COX regression model was used to examine the risk of mortality. RESULTS: A total of 51,691 inpatients were included and 1709 (3.31%) among them developed HCAI. Lower respiratory tract infection and Acinetobacter baumannii were the most prevalent HCAI and causative pathogen in surveyed institute. Generally, the expected extra LOS attributable to HCAI was 2.56 days (95% confidence interval: 2.54-2.61). Patients below 65 had extra LOS attributable to HCAI longer about 2 days than those above. The extra LOS attributable to HCAI of male patients was 1.33 days longer than female. Meanwhile, age above 65 years old and HCAI were the risk factors of mortality for inpatients. CONCLUSIONS: HCAI contributes to an increase in extra LOS of inpatients in China. The effect of HCAI on extra LOS is different among subgroups, with the age below 65, male and medicine department more sensitive.


Asunto(s)
Infección Hospitalaria/diagnóstico , Tiempo de Internación , Infecciones del Sistema Respiratorio/diagnóstico , Acinetobacter baumannii/aislamiento & purificación , Factores de Edad , Anciano , China , Infección Hospitalaria/microbiología , Infección Hospitalaria/mortalidad , Femenino , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/mortalidad , Factores de Riesgo , Factores Sexuales , Tasa de Supervivencia
5.
BMC Infect Dis ; 19(1): 976, 2019 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-31747890

RESUMEN

BACKGROUND: Diagnosing pneumonia can be challenging in general practice but is essential to distinguish from other respiratory tract infections because of treatment choice and outcome prediction. We determined predictive signs, symptoms and biomarkers for the presence of pneumonia in patients with acute respiratory tract infection in primary care. METHODS: From March 2012 until May 2016 we did a prospective observational cohort study in three radiology departments in the Leiden-The Hague area, The Netherlands. From adult patients we collected clinical characteristics and biomarkers, chest X ray results and outcome. To assess the predictive value of C-reactive protein (CRP), procalcitonin and midregional pro-adrenomedullin for pneumonia, univariate and multivariate binary logistic regression were used to determine risk factors and to develop a prediction model. RESULTS: Two hundred forty-nine patients were included of whom 30 (12%) displayed a consolidation on chest X ray. Absence of runny nose and whether or not a patient felt ill were independent predictors for pneumonia. CRP predicts pneumonia better than the other biomarkers but adding CRP to the clinical model did not improve classification (- 4%); however, CRP helped guidance of the decision which patients should be given antibiotics. CONCLUSIONS: Adding CRP measurements to a clinical model in selected patients with an acute respiratory infection does not improve prediction of pneumonia, but does help in giving guidance on which patients to treat with antibiotics. Our findings put the use of biomarkers and chest X ray in diagnosing pneumonia and for treatment decisions into some perspective for general practitioners.


Asunto(s)
Biomarcadores/análisis , Neumonía/diagnóstico , Infecciones del Sistema Respiratorio/diagnóstico , Adulto , Anciano , Antibacterianos/uso terapéutico , Proteína C-Reactiva/análisis , Calcitonina/análisis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Países Bajos , Neumonía/complicaciones , Neumonía/tratamiento farmacológico , Atención Primaria de Salud , Pronóstico , Estudios Prospectivos , Infecciones del Sistema Respiratorio/complicaciones , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Tórax/diagnóstico por imagen
6.
FP Essent ; 486: 11-18, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31710453

RESUMEN

Upper respiratory tract infections (URTIs) include the common cold, rhinosinusitis, pharyngitis, and acute otitis media (AOM). URTIs account for billions of dollars in annual health care costs; acute respiratory tract infections are the most common reason for acute care appointments. Although URTIs typically are viral, these infections are the most common reason for prescription of antibiotics in adults. Recommended therapy for the common cold involves symptom management with over-the-counter drugs, though the Food and Drug Administration advises against use of these drugs in children younger than 6 years. Acute rhinosinusitis also typically is viral. A bacterial etiology is more likely if symptoms last longer than 10 days, the temperature is greater than 39°C (102.2°F), or if symptoms worsen after initial improvement. Antibiotics are not recommended unless symptoms worsen or do not improve after an additional 7 days. Acute pharyngitis also typically is of viral origin. Antibiotics for streptococcal pharyngitis should be prescribed only if test or culture results are positive. AOM can be managed without antibiotics except in children younger than 6 months, children ages 6 to 23 months with bilateral AOM, children older than 2 years with bilateral AOM and otorrhea, and certain high-risk patients.


Asunto(s)
Otitis Media , Faringitis , Infecciones del Sistema Respiratorio , Rinitis , Sinusitis , Enfermedad Aguda , Adulto , Antibacterianos/uso terapéutico , Niño , Humanos , Lactante , Otitis Media/diagnóstico , Otitis Media/tratamiento farmacológico , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Rinitis/diagnóstico , Rinitis/tratamiento farmacológico , Sinusitis/diagnóstico , Sinusitis/tratamiento farmacológico
7.
FP Essent ; 486: 19-25, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31710454

RESUMEN

Acute bronchitis and pneumonia are conditions commonly diagnosed in inpatient and outpatient settings. Acute bronchitis is a lower respiratory tract infection characterized by cough, with or without sputum production, lasting 1 to 3 weeks. It typically is viral. Testing for influenza should be obtained in patients at high risk of influenza complications. Antibiotics are not indicated in patients without chronic lung disease unless Bordetella pertussis infection is suspected. If pertussis is confirmed, macrolide antibiotics should be prescribed. Otherwise, symptom control and patient education are key to management. Community-acquired pneumonia (CAP) is a leading cause of death in children and adults. Diagnosis is based on symptoms and imaging study results. Ultrasonography is more accurate than chest x-rays. Severity scoring systems are used to aid clinical judgement in selecting inpatient versus outpatient management. Antibiotics should be administered according to current guidelines. Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are nosocomial infections with high mortality rates. Microorganisms responsible for HAP and VAP have high rates of resistance and vary based on geographic regions. Implementation of prevention protocols has decreased rates of VAP.


Asunto(s)
Infección Hospitalaria , Gripe Humana , Neumonía Asociada al Ventilador , Infecciones del Sistema Respiratorio , Adulto , Antibacterianos/uso terapéutico , Niño , Humanos , Gripe Humana/diagnóstico , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/tratamiento farmacológico
8.
BMC Infect Dis ; 19(1): 862, 2019 Oct 17.
Artículo en Inglés | MEDLINE | ID: mdl-31623573

RESUMEN

BACKGROUND: Idiopathic CD4 lymphocytopenia (ICL) is a rare clinical disease with relative CD4 deficiency in the absence of HIV infection. The pathogenicity of ICL is poorly understood with an unclear incidence rate in the general population. Sequelae of ICL includes AIDS-defining infections, which most commonly includes Cryptococcus neoformans. Typically, C. neoformans infections present with CNS involvement but rarely with extra-CNS manifestations. Here, we present a rare case of ICL with exclusively primary pulmonary cryptococcus and a review of the literature. CASE PRESENTATION: A 56-year-old female presented to our tertiary care hospital requiring a right hip open reduction intervention. The patient became febrile during admission, prompting a work-up that included a chest X-ray showing a peripheral pulmonary solitary nodule. Transthoracic biopsy revealed encapsulated yeast forms in keeping with C. neoformans. CD4 counts, repeated at least one month apart, were < 200 cells/mm3, with negative HIV testing. Flow cytometry and genetic testing were completed to elucidate the etiology of the immune deficiency, both of which were unremarkable. She was subsequently treated with 12 months of posaconazole with clinical resolution. CONCLUSIONS: Our patient highlights a rare clinical disease, which a review of literature revealed only five cases in the literature with exclusive pulmonary Cryptococcus in ICL/ This case demonstrates the strong clinical acumen required to properly diagnose and ultimately manage the patient.


Asunto(s)
Criptococosis/diagnóstico , Cryptococcus neoformans/aislamiento & purificación , Linfopenia/diagnóstico , Infecciones del Sistema Respiratorio/diagnóstico , Antifúngicos/uso terapéutico , Recuento de Linfocito CD4 , Criptococosis/tratamiento farmacológico , Criptococosis/microbiología , Femenino , Humanos , Pulmón/microbiología , Pulmón/patología , Linfopenia/etiología , Persona de Mediana Edad , Infecciones del Sistema Respiratorio/complicaciones , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/microbiología , Tórax/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Triazoles/uso terapéutico
9.
Adv Exp Med Biol ; 1222: 55-62, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31529287

RESUMEN

In uncomplicated bronchiolitis, chest radiography (CR) is not routinely recommended, yet it is still frequently made. This study seeks to evaluate the use of CR in children with bronchiolitis due to a lower respiratory tract infection (RSV-RTI) with respiratory syncytial virus (RSV) and the influence of CR on patient treatment during the 2010-2017 seasons. There were 581 children included into the study: 459 with bronchiolitis (390 RSV-RTI and 69 non-RSV), 65 with RSV pneumonia and 57 with RSV bronchitis. We found that CR was performed in 28.6% (166/581) patients. CR was much more frequent in patients with RSV than non-RSV infections (61% vs. 31%). CR prognostic sensitivity and specificity in guiding antibiotic treatment was low, 78% and 58%, respectively. Positive and negative predicted values of CR were 78% and 58%, respectively and the number needed to diagnose was 2.777. Children in whom CR was performed (irrespective of the result) were at 22.9-fold higher risk of antibiotic therapy (95%CI: 14.1-37.1; p < 0.01), while those with a positive CR were only at 4.4-fold higher risk of antibiotic therapy (95%CI: 2.2-8.9; p < 0.01). Children with CR required a longer hospital stay than those without it (10 vs. 8 days, respectively; p < 0.01). The percentage of CR decreased from 78% in 2010 to 33% in 2017, with the lowest value of 11% in 2015. The additional cost of CR, which had no influence on treatment, would have been €381 had it been performed in each patient, which amounts to 1% of the total hospitalization cost. We conclude that CR is overused and in most cases it has no influence on the patient management. The recognition of practical meaning of CR is essential to avoid unnecessary radiation of children.


Asunto(s)
Bronquiolitis/diagnóstico por imagen , Hospitalización/estadística & datos numéricos , Radiografía/métodos , Infecciones por Virus Sincitial Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Bronquiolitis/epidemiología , Bronquiolitis/virología , Preescolar , Humanos , Lactante , Tiempo de Internación , Neumonía/epidemiología , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Infecciones por Virus Sincitial Respiratorio/diagnóstico , Virus Sincitial Respiratorio Humano/aislamiento & purificación , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/virología
10.
BMC Infect Dis ; 19(1): 770, 2019 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-31481020

RESUMEN

BACKGROUND: We sought to assess reporting in China's Pneumonia of Unknown Etiology (PUE) passive surveillance system for emerging respiratory infections and to identify ways to improve the PUE surveillance system's detection of respiratory infections of public health significance. METHODS: From February 29-May 29, 2016, we actively identified and enrolled patients in two hospitals with acute respiratory infections (ARI) that met all PUE case criteria. We reviewed medical records for documented exposure history associated with respiratory infectious diseases, collected throat samples that were tested for seasonal and avian influenza, and interviewed clinicians regarding reasons for reporting or not reporting PUE cases. We described and analyzed the proportion of PUE cases reported and clinician awareness of and practices related to the PUE system. RESULTS: Of 2619 ARI admissions in two hospitals, 335(13%) met the PUE case definition; none were reported. Of 311 specimens tested, 18(6%) were seasonal influenza virus-positive; none were avian influenza-positive. < 10% PUE case medical records documented whether or not there were exposures to animals or others with respiratory illness. Most commonly cited reasons for not reporting cases were no awareness of the PUE system (76%) and not understanding the case definition (53%). CONCLUSIONS: Most clinicians have limited awareness of and are not reporting to the PUE system. Exposures related to respiratory infections are rarely documented in medical records. Increasing clinicians' awareness of the PUE system and including relevant exposure items in standard medical records may increase reporting.


Asunto(s)
Notificación de Enfermedades , Necesidades y Demandas de Servicios de Salud , Neumonía/epidemiología , Neumonía/etiología , Vigilancia de la Población , Adulto , China/epidemiología , Enfermedades Transmisibles Emergentes/diagnóstico , Enfermedades Transmisibles Emergentes/epidemiología , Diagnóstico Diferencial , Notificación de Enfermedades/métodos , Notificación de Enfermedades/normas , Femenino , Necesidades y Demandas de Servicios de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/normas , Hospitalización , Humanos , Gripe Humana/epidemiología , Masculino , Notificación Obligatoria , Exámenes Obligatorios/normas , Persona de Mediana Edad , Proyectos Piloto , Neumonía/diagnóstico , Vigilancia de la Población/métodos , Pautas de la Práctica en Medicina/organización & administración , Pautas de la Práctica en Medicina/normas , Evaluación de Programas y Proyectos de Salud , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/etiología , Compromiso Laboral
11.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(8): 904-910, 2019 Aug 10.
Artículo en Chino | MEDLINE | ID: mdl-31484252

RESUMEN

Objective: To analyze the etiologic and epidemiological characteristics of adult acute respiratory infections in Shanghai during 2015-2017. Methods: Data was collected from outpatients with acute respiratory infections who visited the Fever Clinics in three hospitals of different levels in three administrative regions of Shanghai, from 2015 to 2017. Basic information and nasopharyngeal swabs were collected from cases in line with the inclusion criteria. Multiplex RT-PCR and bacterial cultures were performed to detect the respiratory pathogens. Results: A total of 806 individuals were enrolled from 2015 to 2017. Respiratory pathogens were identified in 73.45% (592/806) of the cases, with the virus detection rate as 66.75% (538/806). It was found that the major respiratory pathogens for virus detection were influenza A in 326 (40.45%), influenza B in 116 (14.39%), rhinovirus/enterovirus in 39 (4.84%) of the cases. The overall detection rate of bacteria was 16.13% (130/806), including Klebsiella pneumoniae in 90 (11.17%) cases, Staphylococcus Aureus in 46 (5.71%) cases. Other kind of bacteria were not detected in our study. The detection rates on Mycoplasma pneumoniae was 5.33% (43/806) and on Chlamydia pneumonia was 0.37% (3/806). Co-infection with multiple pathogens was detected in 18.61% (150/806) of the cases, including 135 with double infection (accounting for 90.00%), 14 with triple infection and 1 with quadruple infection (accounted for 9.33% and 0.67%, respectively). Among the 150 cases with co-infections, the main identified pathogens were influenza A, Klebsiella pneumoniae, Staphylococcus aureus, and Mycoplasma pneumoniae. Pathogens of acute respiratory infections that identified among the outpatients from the Fever Clinics at different time, region or population, the characteristics were different (P<0.001). Conclusions: In 2015-2017, outpatients with acute respiratory infections in Shanghai were mainly caused by influenza virus or other viruses, however dynamically with its composition, time, region and characteristics of the population. It is necessary to strengthen and combine related medical and preventive services and to develop the appropriate strategies regarding clinical diagnosis and treatment.


Asunto(s)
Bacterias/aislamiento & purificación , Infecciones Bacterianas/diagnóstico , Gripe Humana/diagnóstico , Reacción en Cadena de la Polimerasa Multiplex/métodos , Nasofaringe , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/etiología , Virosis/diagnóstico , Virus/aislamiento & purificación , Enfermedad Aguda , Adulto , Bacterias/genética , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , China/epidemiología , Coinfección/diagnóstico , Enterovirus/genética , Enterovirus/aislamiento & purificación , Monitoreo Epidemiológico , Humanos , Incidencia , Virus de la Influenza A/genética , Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza B/genética , Virus de la Influenza B/aislamiento & purificación , Gripe Humana/epidemiología , Gripe Humana/virología , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/aislamiento & purificación , Mycoplasma pneumoniae , Nasofaringe/microbiología , Nasofaringe/virología , Vigilancia de la Población , Infecciones del Sistema Respiratorio/diagnóstico , Rhinovirus/genética , Rhinovirus/aislamiento & purificación , Staphylococcus aureus/genética , Staphylococcus aureus/aislamiento & purificación , Virosis/epidemiología , Virosis/virología , Virus/genética
12.
BMC Infect Dis ; 19(1): 764, 2019 Sep 02.
Artículo en Inglés | MEDLINE | ID: mdl-31477038

RESUMEN

BACKGROUND: Environmental bacteria, nontuberculous mycobacteria (NTM), are recognized as one of the major human infection pathogens. NTM are prone to be mistaken as multidrug-resistant Mycobacterium tuberculosis and challenge our fight against TB. In addition, treatment of NTM per se is intractable. Remarkably, the distribution of NTM pathogenic species is geographically specific. Thus, it is very important to summarize the prevalent features and clinical symptoms of NTM pulmonary disease. However, In Nanjing district, southeast China, there is no such a report. METHODS: Through investigating electronic medical records and analyzing data of clinical examination system (Lis), we retrospectively summarized the NTM species from 6012 clinical isolates from May 2017 to August 2018, and analyzed the association between NTM species and clinical symptoms. RESULTS: Of 6012 clinical specimens, 1461 (24.3%) could grow in the MGIT 960 broth. Among these positive isolates, 1213 (83%) were M. tuberculosis, 22 (1.5%) were M. bovis, and 226 (15.5%) were NTM. After deducting redundancy, those NTM specimens were confirmed from 154 patients, among which, 87 (56.5%) patients met the full ATS/IDSA NTM disease criteria. The most common etiologic agent was M. intracellulare (70.1%). NTM infection was associated with age, based on which 68.6% male patients and 77.8% female patients were over 50 years old. The older patients were more likely to have hemoptysis, but the younger patients were more likely to manifest chest congestion. Male patients were more likely to have shortness of breath and females were more likely to have hemoptysis. The most common radiographic presentation of NTM pulmonary disease was bronchiectasis, accounting for 39.1%. Remarkably, multiple and thin-walled cavities were outstanding. The most frequent comorbidity of NTM disease was previous tuberculosis (64%), followed by clinical bronchiectasis (19.5%), HIV (19.5%), and 6.9% chronic obstructive pulmonary disease (COPD). There was no association between NTM species and clinical symptoms. CONCLUSION: This study retrospectively investigated the prevalence of NTM pulmonary disease in Nanjing district, southeast China. Similar to Beijing area, north China, M. intracellulare was the major pathogenic NTM species. Clinical symptoms of the disease were not species-specific. Previous TB and HIV infection immensely enhanced risk of NTM disease.


Asunto(s)
Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/epidemiología , Infecciones por Micobacterias no Tuberculosas/diagnóstico , Infecciones por Micobacterias no Tuberculosas/epidemiología , Micobacterias no Tuberculosas/aislamiento & purificación , Adulto , Anciano , Anciano de 80 o más Años , Bronquiectasia/diagnóstico , Bronquiectasia/epidemiología , Bronquiectasia/microbiología , China/epidemiología , Comorbilidad , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/microbiología , Humanos , Enfermedades Pulmonares/microbiología , Masculino , Persona de Mediana Edad , Infecciones por Micobacterias no Tuberculosas/microbiología , Micobacterias no Tuberculosas/clasificación , Prevalencia , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/microbiología , Estudios Retrospectivos , Adulto Joven
13.
Clin Sports Med ; 38(4): 563-575, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31472767

RESUMEN

Respiratory symptoms and infections are common among athletes. Viral upper respiratory infection symptoms may precede dyspneic symptoms seen in asthmatics or worsen symptoms of exercise-induced bronchoconstriction Knowing how to instruct an athlete on use of inhalers and having an asthma action plan are critical in management of these athletes. Other life-threatening conditions that may be seen are pneumothorax and laryngeal/pharyngeal perforation. Prompt recognition and treatment are crucial if an athlete is suspected to have pulmonary compromise. Laryngeal/pharyngeal perforations are a rare cause of issues within the training room but require a high degree of suspicion to be diagnosed and managed properly.


Asunto(s)
Asma/tratamiento farmacológico , Broncoconstricción , Ejercicio/fisiología , Neumotórax , Infecciones del Sistema Respiratorio , Volver al Deporte , Asma/diagnóstico , Humanos , Laringe/lesiones , Sustancias para Mejorar el Rendimiento , Faringe/lesiones , Neumotórax/diagnóstico , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/terapia , Disfunción de los Pliegues Vocales/diagnóstico , Heridas y Traumatismos/diagnóstico
15.
Mayo Clin Proc ; 94(9): 1781-1785, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31400906

RESUMEN

OBJECTIVE: To evaluate the diagnostic yield of fungal smears and cultures from bronchial lavage and wash specimens obtained from immunocompetent patients in the intensive care unit (ICU) because respiratory tract samples from patients in the ICU often undergo extensive microbiological testing. PATIENTS AND METHODS: In total, we enrolled 112 immunocompetent adult patients treated in the medical and surgical ICU between July 1, 2016, and June 30, 2017. We evaluated whether the results of fungal smears and cultures of specimens obtained from bronchoscopy and bronchoalveolar lavage changed patient care. RESULTS: In total, 131 bronchoscopic specimens and 31 bronchoalveolar lavage specimens were tested for fungi. Cultures were held for an estimated 4680 culture-days. Two results changed patient therapy. In both cases, other routine tests provided the same information as fungal culture before these results were returned. CONCLUSION: In immunocompetent, critically ill patients, fungal culture of respiratory tract specimens does not add diagnostic value. Routine fungal culture of respiratory tract specimens should be discouraged in this population.


Asunto(s)
Antifúngicos/uso terapéutico , Líquido del Lavado Bronquioalveolar/microbiología , Hongos/aislamiento & purificación , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/microbiología , Adulto , Lavado Broncoalveolar/métodos , Broncoscopía/métodos , Estudios de Cohortes , Enfermedad Crítica , Técnicas de Cultivo , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Pronóstico , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/inmunología , Estudios Retrospectivos , Medición de Riesgo , Resultado del Tratamiento , Procedimientos Innecesarios/métodos
16.
J Bras Pneumol ; 45(4): e20190122, 2019 Aug 12.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31411280

RESUMEN

Bronchiectasis is a condition that has been increasingly diagnosed by chest HRCT. In the literature, bronchiectasis is divided into bronchiectasis secondary to cystic fibrosis and bronchiectasis not associated with cystic fibrosis, which is termed non-cystic fibrosis bronchiectasis. Many causes can lead to the development of bronchiectasis, and patients usually have chronic airway symptoms, recurrent infections, and CT abnormalities consistent with the condition. The first international guideline on the diagnosis and treatment of non-cystic fibrosis bronchiectasis was published in 2010. In Brazil, this is the first review document aimed at systematizing the knowledge that has been accumulated on the subject to date. Because there is insufficient evidence on which to base recommendations for various treatment topics, here the decision was made to prepare an expert consensus document. The Brazilian Thoracic Association Committee on Respiratory Infections summoned 10 pulmonologists with expertise in bronchiectasis in Brazil to conduct a critical assessment of the available scientific evidence and international guidelines, as well as to identify aspects that are relevant to the understanding of the heterogeneity of bronchiectasis and to its diagnostic and therapeutic management. Five broad topics were established (pathophysiology, diagnosis, monitoring of stable patients, treatment of stable patients, and management of exacerbations). After this subdivision, the topics were distributed among the authors, who conducted a nonsystematic review of the literature, giving priority to major publications in the specific areas, including original articles, review articles, and systematic reviews. The authors reviewed and commented on all topics, producing a single final document that was approved by consensus.


Asunto(s)
Bronquiectasia/diagnóstico por imagen , Bronquiectasia/terapia , Consenso , Brasil , Bronquiectasia/etiología , Bronquiectasia/fisiopatología , Enfermedad Crónica , Manejo de la Enfermedad , Humanos , Calidad de Vida , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/etiología , Infecciones del Sistema Respiratorio/fisiopatología , Infecciones del Sistema Respiratorio/terapia , Tomografía Computarizada por Rayos X/métodos
17.
Internist (Berl) ; 60(11): 1136-1145, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31455974

RESUMEN

BACKGROUND: There are six human pathogenic coronaviruses (CoV), which mainly cause infections of the respiratory system. In everyday clinical practice, it is helpful to know the relevance and characteristics of these pathogens. OBJECTIVE: To present the epidemiology, clinical picture and differences of human pathogenic CoV and to provide information on the diagnostics and treatment of patients suspected of having CoV infections. MATERIAL AND METHODS: Selective literature search, presentation of results and discussion of fundamental works and expert recommendations, including publications by the World Health Organization (WHO), the European Centre for Disease Prevention and Control (ECDC) and the Robert Koch Institute. RESULTS: The four endemic human CoVs (HCoV-NL63, HCoV-229E, HCoV-OC43 and HCoV-HKU1) mainly cause mild respiratory tract infections. In addition to these four endemic HCoV, the two epidemic CoV, severe acute respiratory syndrome (SARS)-CoV and Middle East respiratory syndrome (MERS)-CoV can cause severe pneumonia. The SARS-CoV has not been detected in humans in the last 15 years and MERS-CoV has been circulating mainly on the Arabian Peninsula since 2012; however, neither a specific treatment nor approved vaccines exist for any of the six human pathogenic CoVs. CONCLUSION: All six human CoVs can be diagnosed using RT-PCR on respiratory specimens but this is rarely necessary for the four endemic strains. In current clinical practice SARS-CoV has no importance as it has not been detected in humans for 15 years; however, a possible MERS-CoV infection should be taken into account in patients with typical symptoms and travel history to endemic regions. In this case, rapid diagnostic and general hygiene practices are important to prevent further transmission.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/prevención & control , Coronavirus , Infecciones del Sistema Respiratorio , Síndrome Respiratorio Agudo Grave/diagnóstico , Betacoronavirus , Coronavirus Humano 229E , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Coronavirus Humano NL63 , Coronavirus Humano OC43 , Humanos , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/virología , Síndrome Respiratorio Agudo Grave/epidemiología , Síndrome Respiratorio Agudo Grave/prevención & control , Síndrome Respiratorio Agudo Grave/virología
18.
Indian J Med Microbiol ; 37(1): 105-108, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31424019

RESUMEN

Historical specimens collected from hospitalized children were tested for the following 13 viruses: influenza A and B; respiratory syncytial virus (RSV); parainfluenza viruses 1-3; human metapneumovirus; rhinovirus; coronaviruses 229E, OC43, NL63 and HKU1 and Adenovirus using monoplex real-time reverse transcriptase polymerase chain reaction (rRT-PCR). They were retested using TaqMan Array Card (TAC), a micro-fluidic system, capable of simultaneous multi-pathogen testing, to evaluate its sensitivity and specificity against monoplex rRT-PCR. TAC showed high sensitivity (71%-100%) and specificity (98%-100%) for these viruses in comparison to monoplex rRT-PCR. Multi-specimen detection with high sensitivity and specificity makes TAC a potentially useful tool for both surveillance and outbreak investigations.


Asunto(s)
Dispositivos Laboratorio en un Chip , Técnicas Analíticas Microfluídicas/métodos , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/virología , Preescolar , Humanos , India , Lactante , Recién Nacido , Técnicas de Diagnóstico Molecular/métodos , Sensibilidad y Especificidad , Virus/aislamiento & purificación
19.
Indian J Med Microbiol ; 37(1): 127-131, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31424025

RESUMEN

We report here the first case of pulmonary infection due to Mycobacterium kyorinense in a 55-year-old hypertensive woman treated for pulmonary tuberculosis earlier on two occasions. She presented with productive cough, intermittent episode of left-sided chest pain, loss of appetite, low-grade fever, and breathlessness. Sputum cultures revealed non-tuberculous mycobacteria (NTM). She remained persistently symptomatic with sputum cultures positive for acid-fast bacilli even after 6 months of treatment. Hence, a 16SrRNA gene amplification and sequencing were done that revealed M. kyorinense. Based on the guidelines of the American Thoracic Society, she was started on weight-based dosing of clarithromycin, levofloxacin, ethambutol, isoniazid and injection amikacin daily. The patient improved symptomatically and became culture-negative after 3 months of therapy with the above regimen and continued to be culture negative for 12 months of treatment. She continues to remain symptom-free without evidence of any clinical or bacteriological relapse.


Asunto(s)
Antituberculosos/uso terapéutico , Infecciones por Micobacterias no Tuberculosas/diagnóstico , Infecciones por Micobacterias no Tuberculosas/tratamiento farmacológico , Mycobacterium/genética , Infecciones del Sistema Respiratorio/diagnóstico , Amicacina/uso terapéutico , Claritromicina/uso terapéutico , Etambutol/uso terapéutico , Femenino , Humanos , Isoniazida/uso terapéutico , Levofloxacino/uso terapéutico , Persona de Mediana Edad , Mycobacterium/aislamiento & purificación , Infecciones por Micobacterias no Tuberculosas/microbiología , ARN Ribosómico 16S/genética , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/microbiología
20.
Emerg Infect Dis ; 25(9): 1756-1758, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31441750

RESUMEN

We identified a case of fatal acute respiratory disease from household transmission of human adenovirus type 55 (HAdV-55) in Anhui Province, China. Computed tomography showed severe pneumonia. Comparative genomic analysis of HAdV-55 indicated the virus possibly originated in Shanxi Province, China. More attention should be paid to highly contagious HAdV-55.


Asunto(s)
Infecciones por Adenovirus Humanos/diagnóstico , Adenovirus Humanos/aislamiento & purificación , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones por Adenovirus Humanos/transmisión , Adenovirus Humanos/genética , Adulto , Preescolar , Diagnóstico Diferencial , Transmisión de Enfermedad Infecciosa , Composición Familiar , Resultado Fatal , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Infecciones del Sistema Respiratorio/transmisión , Adulto Joven
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