Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.988
Filtrar
1.
MedEdPORTAL ; 16: 11058, 2020 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-33365392

RESUMO

Introduction: The COVID-19 pandemic has radically disrupted traditional models of medical education, forcing rapid evolution in the delivery of clinical training. As a result, clinical educators must quickly transition away from in-person sessions and develop effective virtual learning opportunities instead. This virtual resource was designed to replace a clinical simulation session for the physical examination course for medical students in the preclinical years. Methods: We designed an online interactive module in three sections for preclinical (first- or second-year) medical students who had not yet learned the respiratory physical exam. The first section incorporated demonstration and practice of the components of the respiratory physical exam that could be effectively taught via videoconferencing software. Following this, students conducted a telemedicine encounter with a standardized patient and received patient-centered feedback evaluating their communication skills. The final segment involved a case discussion and clinical reasoning component. Results: These sessions were implemented for 122 first-year medical students. The module was well received by the students. A majority felt that it helped improve their telemedicine communication skills (93%), interpretation of physical exam findings (84%), development of differential diagnosis (95%), and correlation of clinical and basic science content (93%). Discussion: Our pilot educational session demonstrates that this virtual instruction method is an effective tool for teaching basic clinical skills during medical school. Virtual learning resources allow remote instruction to take place and can be a supplement when face-to-face clinical teaching is not possible.


Assuntos
Competência Clínica , Infecções Comunitárias Adquiridas/diagnóstico , Instrução por Computador , Tosse/etiologia , Educação de Graduação em Medicina/métodos , Exame Físico , Pneumonia/diagnóstico , /diagnóstico , Comunicação , Diagnóstico Diferencial , Feedback Formativo , Humanos , Anamnese , Pandemias , Exame Físico/métodos , Projetos Piloto , Consulta Remota
2.
J Korean Med Sci ; 35(47): e390, 2020 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-33289366

RESUMO

BACKGROUND: This study is to describe the changes in prescribing practices of antibiotics to treat community-acquired pneumonia (CAP) in Korea during 2010-2015. METHODS: The claim database of the Health Insurance Review and Assessment Service in Korea was used to select adult patients (≥ 18 years of age) admitted between 2010 and 2015, with the International Classification of Diseases, Tenth Revision codes relevant to all-cause pneumonia for the first or second priority discharge diagnosis. The episodes with hospital-acquired or healthcare-associated pneumonia were excluded. Consumption of each antibiotic was converted to defined daily dose (DDD) per episode. The amount of antibiotic consumption was compared between patients with CAP aged < 65 years and those aged ≥ 65 years. RESULTS: The average amount of antibiotic consumption per episode was 15.5 DDD, which remained stable throughout the study period (P = 0.635). Patients aged ≥ 65 years received more antibiotics than those aged < 65 years (15.7 vs. 15.3 DDD). Third-generation cephalosporin (4.9 DDD/episode, 31.4%) was the most commonly prescribed, followed by macrolide (2.7 DDD/episode, 17.1%) and beta-lactam/beta-lactamase inhibitor (BL/BLI) (2.1 DDD/episode, 13.6%). The consumption amount of fourth-generation cephalosporin (4th CEP) (P = 0.001), BL/BLI (P = 0.003) and carbapenem (P = 0.002) increased each year during the study period. The consumption of 4th CEP and carbapenem was doubled during 2010-2015. CONCLUSION: The prescription of broad-spectrum antibiotics such as 4th CEP and carbapenem to treat CAP increased in Korea during 2010-2015.


Assuntos
Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Bases de Dados Factuais , Pneumonia/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Cefalosporinas/uso terapêutico , Infecções Comunitárias Adquiridas/diagnóstico , Comorbidade , Feminino , Hospitalização , Humanos , Macrolídeos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico , República da Coreia
3.
Can Respir J ; 2020: 8715756, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33294084

RESUMO

Background: Nonresponding pneumonia is responsible for the most mortality of community-acquired pneumonia (CAP). However, thus far, it is not clear whether viral infection plays an important role in the etiology of nonresponding CAP and whether there is a significant difference in the clinical characteristics between viral and nonviral nonresponding CAP. Methods: From 2016 to 2019, nonresponding CAP patients were retrospectively enrolled in our study. All patients received bronchoalveolar lavage (BAL) and virus detection in BAL fluid by multiplex real-time polymerase chain reaction (PCR), and clinical, laboratory, and radiographic data were collected. Results: A total of 43 patients were included. The median age was 62 years, and 65.1% of patients were male. Overall, 20 patients (46.5%) were identified with viral infection. Of these viruses, influenza virus (n = 8) and adenovirus (n = 7) were more frequently detected, and others included herpes simplex virus, human enterovirus, cytomegalovirus, human coronavirus 229E, rhinovirus, and parainfluenza virus. Compared with nonviral nonresponding CAP, only ground-glass opacity combined with consolidation was a more common imaging manifestation in viral nonresponding CAP. However, no obvious differences were found in clinical and laboratory findings between the presence and the absence of viral infections. Conclusions: Viral infections were particularly frequent in adults with nonresponding CAP. The ground-glass opacity combined with consolidation was a specific imaging manifestation for viral nonresponding CAP, while the clinical and laboratory data showed no obvious differences between viral and nonviral nonresponding CAP.


Assuntos
Líquido da Lavagem Broncoalveolar/virologia , Reação em Cadeia da Polimerase Multiplex , Pneumonia Viral/diagnóstico , Reação em Cadeia da Polimerase em Tempo Real , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/virologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Viral/virologia , Estudos Retrospectivos , Adulto Jovem
4.
BMC Infect Dis ; 20(1): 908, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33256619

RESUMO

BACKGROUND: Diarrhoea, affecting children in developing countries, is mainly caused by diarrheagenic Escherichia coli (DEC). This study principally aimed to determine the prevalence of DEC pathotypes and Extended-spectrum ß-lactamase (ESBL) genes isolated from children under 5 years old with diarrhea. METHODS: A total of 320 diarrhoea stool samples were investigated. E. coli isolates were investigated for genes specific for enterotoxigenic E. coli (ETEC), enteropathogenic E. coli (EPEC), enteroaggregative E. coli (EAEC), enteroinvasive E. coli (EIEC) and enterohemorrhagic E. coli (EHEC) using polymerase chain reaction (PCR). Furthermore, antimicrobial susceptibility testing, detection of antibiotic resistance-genes and phylogenetic typing were performed. RESULTS: Over all, DEC were isolated from 66/320 (20.6%) of the children with diarrhoea. EAEC was the predominant (47%), followed by typical EPEC (28.8%) and atypical EPEC (16.6%). Co-infection by EPEC and EAEC was detected in (7.6%) of isolates. However, ETEC, EIEC and EHEC were not detected. Phylogroup A (47%) and B2 (43.9%) were the predominant types. Multidrug-resistance (MDR) was found in 55% of DEC isolates. Extended-spectrum ß-lactamase (ESBL) genes were detected in 24 isolates (24 blaTEM and 15 blaCTX-M-15). Only one isolate harbored AmpC ß-lactamase gene (DHA gene). CONCLUSION: The study concluded that, EAEC and EPEC are important causative agents of diarrhoea in children under 5 years. MDR among DEC has the potential to be a big concern.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Diarreia/diagnóstico , Farmacorresistência Bacteriana Múltipla/genética , Escherichia coli Enteropatogênica/genética , Infecções por Escherichia coli/diagnóstico , Escherichia coli/genética , Filogenia , Antibacterianos/uso terapêutico , Proteínas de Bactérias/genética , Pré-Escolar , Estudos de Coortes , Coinfecção/diagnóstico , Coinfecção/microbiologia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Diarreia/tratamento farmacológico , Diarreia/epidemiologia , Diarreia/microbiologia , Egito/epidemiologia , Escherichia coli Enteropatogênica/enzimologia , Escherichia coli Enteropatogênica/isolamento & purificação , Escherichia coli/enzimologia , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Fezes/microbiologia , Feminino , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Reação em Cadeia da Polimerase , Prevalência , beta-Lactamases/genética
5.
Adv Gerontol ; 33(3): 471-478, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33280331

RESUMO

Despite of advances in diagnostics and treatment of respiratory tract infections, respiratory tract bacterial infections morbidity is still remaining the significant problem of modern medicine. Moreover, microbiological diagnostics of etiology identified in community-acquired aged patients pathogens spectrum allows to consider the main causative agent Streptococcus pneumoniae. Antimicrobial agents resistance of this pathogen is the actual problem in treatment of all forms of pneumococcal infections and is till one of the factor defining the epidemiology significance of pneumococcal infection as the source of forming of epidemiological clone. Aim of our study was to estimate the peculiarities of antimicrobial agents resistance of S. pneumoniae strains, isolated in aged patients with diagnosis of community-acquired pneumonia and bronchitis. There were used such methods as disco-diffusion method, method of minimum inhibitory concentration, strains were isolated from patients with community-acquired pneumonia, bronchitis, and carriers, then there were conducted molecular epidemiology monitoring of the isolated strains to the main antimicrobial agents resistance determinants. There were revealed that in all groups multidrugresistance had been caused with the similar process of forming to macrolides. In colculsion, the gained results allows to consider that in population causing invasive and non-invasive forms there are the same processes of antimicrobial agents resistance to macrolides.


Assuntos
Infecções Comunitárias Adquiridas , Pneumonia Pneumocócica , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Farmacorresistência Bacteriana , Humanos , Epidemiologia Molecular , Pacientes , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/tratamento farmacológico , Pneumonia Pneumocócica/epidemiologia
6.
Egypt J Immunol ; 27(1): 37-44, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33180386

RESUMO

For community acquired pneumonia (CAP), the discrimination between typical and atypical bacterial causes could influence antibiotic choice and outcome of patients. Objective of this study was to evaluate the utility of serum procalcitonin (PCT) level as a diagnostic and prognostic marker for CAP. Typical bacteria were isolated and identified by conventional methods. An indirect immunoflourescence assay was used to diagnose atypical bacteria. Serum level of PCT was measured by ELISA and clinical outcome was evaluated. Out of 240 enrolled CAP patients, 95 (39.6%) had bacterial etiology (30.8 % typical bacterial pneumonia and 8.8% atypical pneumonia). Ninety five bacterial CAP patients were divided into 3 groups; group 1 (mortality, 20.1%), group 2 (complications, 52.6 %) and group 3 (discharge, 26.3 %). Group 1 patients had the highest PCT level in serum compared to other groups with a statistically significant difference (P < 0.001). A statistically significant higher serum level of PCT was detected in typical than atypical pneumonia (P < 0.001). In conclusion, serum PCT level may serve as a diagnostic and prognostic marker in CAP.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Pneumonia Bacteriana , Pró-Calcitonina/sangue , Bactérias/isolamento & purificação , Biomarcadores , Proteína C-Reativa , Infecções Comunitárias Adquiridas/microbiologia , Humanos , Pneumonia Bacteriana/sangue , Pneumonia Bacteriana/diagnóstico , Prognóstico
7.
BMC Infect Dis ; 20(1): 821, 2020 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-33172398

RESUMO

BACKGROUND: Although Moraxella catarrhalis (M. catarrhalis) is a common cause of community-acquired pneumonia (CAP), studies investigating clinical manifestations of CAP due to M. catarrhalis (MC-CAP) in adults are limited. Since S. pneumoniae is the leading cause of CAP globally, it is important to distinguish between MC-CAP and CAP due to S. pneumoniae (SP-CAP) in clinical practice. However, no past study compared clinical characteristics of MC-CAP and SP-CAP by statistical analysis. We aimed to clarify the clinical characteristics of MC-CAP by comparing those of SP-CAP, as well as the utility of sputum Gram staining. METHODS: This retrospective study screened CAP patients aged over 20 years visiting or admitted to Okinawa Miyako Hospital between May 2013 and April 2018. Among these, we included patients whom either M. catarrhalis alone or S. pneumoniae alone was isolated from their sputum by bacterial cultures. RESULTS: We identified 134 MC-CAP and 130 SP-CAP patients. Although seasonality was not observed in SP-CAP, almost half of MC-CAP patients were admitted in the winter. Compared to those with SP-CAP, MC-CAP patients were older (p < 0.01) and more likely to have underlying pulmonary diseases such as asthma and bronchiectasis (p < 0.01). Approximately half of asthmatic MC-CAP and SP-CAP patients had asthma attacks. Although winter is an influenza season in Japan, co-infection with influenza virus was less common in MC-CAP compared to SP-CAP patients (3% vs. 15%, p < 0.01). Bronchopneumonia patterns on X-ray, as well as bronchial wall thickening, bilateral distribution, and segmental pattern on CT were more common in MC-CAP patients than in SP-CAP patients (p < 0.01). Sputum Gram stain was highly useful method for the diagnosis in both MC-CAP and SP-CAP (78.4% vs. 89.2%), and penicillins were most frequently chosen as an initial treatment for both pneumonias. CONCLUSIONS: This is the first study to show that MC-CAP occurred in older people compared to SP-CAP, influenza virus co-infection was less common in MC-CAP than SP-CAP, and that MC-CAP frequently caused asthma attacks. Gram stain contributed for the appropriate treatment, resulting in conserving broad-spectrum antibiotics such as cephalosporins and fluoroquinolones in both MC-CAP and SP-CAP patients.


Assuntos
Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Moraxella catarrhalis/isolamento & purificação , Pneumonia/diagnóstico , Pneumonia/tratamento farmacológico , Streptococcus pneumoniae/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Violeta Genciana , Hospitalização , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Fenazinas , Pneumonia/microbiologia , Estudos Retrospectivos , Escarro/microbiologia , Coloração e Rotulagem , Resultado do Tratamento , Adulto Jovem
8.
PLoS One ; 15(11): e0241724, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33237924

RESUMO

INTRODUCTION: Sources of infection of most cases of community-acquired Legionnaires' disease (CALD) are unknown. OBJECTIVE: Identification of sources of infection of CALD. SETTING: Berlin; December 2016-May 2019. PARTICIPANTS: Adult cases of CALD reported to district health authorities and consenting to the study; age and hospital matched controls. MAIN OUTCOME MEASURE: Percentage of cases of CALD with attributed source of infection. METHODS: Analysis of secondary patient samples for monoclonal antibody (MAb) type (and sequence type); questionnaire-based interviews, analysis of standard household water samples for Legionella concentration followed by MAb (and sequence) typing of Legionella pneumophila serogroup 1 (Lp1) isolates; among cases taking of additional water samples to identify the infectious source as appropriate; recruitment of control persons for comparison of exposure history and Legionella in standard household water samples. For each case an appraisal matrix was filled in to attribute any of three source types (external (non-residence) source, residential non-drinking water (RnDW) source (not directly from drinking water outlet), residential drinking water (RDW) as source) using three evidence types (microbiological results, cluster evidence, analytical-comparative evidence (using added information from controls)). RESULTS: Inclusion of 111 study cases and 202 controls. Median age of cases was 67 years (range 25-93 years), 74 (67%) were male. Among 65 patients with urine typable for MAb type we found a MAb 3/1-positive strain in all of them. Compared to controls being a case was not associated with a higher Legionella concentration in standard household water samples, however, the presence of a MAb 3/1-positive strain was significantly associated (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.7 to 11). Thus, a source was attributed by microbiological evidence if it contained a MAb 3/1-positive strain. A source was attributed by cluster evidence if at least two cases were exposed to the same source. Statistically significant general source types were attributed by calculating the population attributable risk (analytical-comparative evidence). We identified an external source in 16 (14%) cases, and RDW as source in 28 (25%). Wearing inadequately disinfected dentures was the only RnDW source significantly associated with cases (OR = 3.2, 95% CI 1.3 to 7.8) and led to an additional 8% of cases with source attribution, for a total of 48% of cases attributed. CONCLUSION: Using the appraisal matrix we attributed almost half of all cases of CALD to an infectious source, predominantly RDW. Risk for LD seems to be conferred primarily by the type of Legionella rather than the amount. Dentures as a new infectious source needs further, in particular, integrated microbiological, molecular and epidemiological confirmation.


Assuntos
Legionella pneumophila/isolamento & purificação , Doença dos Legionários/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/imunologia , Berlim/epidemiologia , Estudos de Casos e Controles , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Dentaduras/microbiologia , Desinfetantes/farmacologia , Água Potável/microbiologia , Feminino , Humanos , Legionella pneumophila/efeitos dos fármacos , Legionella pneumophila/imunologia , Doença dos Legionários/epidemiologia , Doença dos Legionários/microbiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Microbiologia da Água
9.
Am J Nurs ; 120(12): 34-42, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33181526

RESUMO

Among the most common causes of U.S. adult hospitalizations, pneumonia accounted for nearly 50,000 deaths in the United States in 2017. This article provides nurses with a thorough update on pneumonia risk factors, signs and symptoms, and diagnostic criteria, as well as inpatient treatment recommendations and recommendations for discharge and prevention, including the nurse's role in patient and family teaching. The article also details key similarities and differences between the new 2019 guideline jointly developed by the American Thoracic Society and the Infectious Diseases Society of America on diagnosis and treatment of adults with community-acquired pneumonia and their earlier 2007 guideline. One crucial difference is the growing recognition that the etiology of pneumonia is changing, necessitating the abandonment of prior categorizations of pneumonia type when determining antibiotic coverage in favor of reliance on local epidemiology and validated risk factors for antimicrobial resistance.


Assuntos
Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Papel do Profissional de Enfermagem , Pneumonia/diagnóstico , Pneumonia/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Hospitalização , Humanos , Educação de Pacientes como Assunto , Pneumonia/epidemiologia , Guias de Prática Clínica como Assunto , Fatores de Risco , Estados Unidos/epidemiologia
11.
BMC Infect Dis ; 20(1): 668, 2020 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-32919458

RESUMO

BACKGROUND: The study was to evaluate initial antimicrobial regimen and clinical outcomes and to explore risk factors for clinical failure (CF) in elderly patients with community-acquired pneumonia (CAP). METHODS: 3011 hospitalized elderly patients were enrolled from 13 national teaching hospitals between January 1, 2014 and December 31, 2014 initiated by the CAP-China network. Risk factors for CF were screened by multivariable logistic regression analysis. RESULTS: The incidence of CF in elderly CAP patients was 13.1%. CF patients were older, longer hospital stays and higher treatment costs than clinical success (CS) patients. The CF patients were more prone to present hyperglycemia, hyponatremia, hypoproteinemia, pleural effusion, respiratory failure and cardiovascular events. Inappropriate initial antimicrobial regimens in CF group were significantly higher than CS group. Undertreatment, CURB-65, PH < 7.3, PaO2/FiO2 < 200 mmHg, sodium < 130 mmol/L, healthcare-associated pneumonia, white blood cells > 10,000/mm3, pleural effusion and congestive heart failure were independent risk factors for CF in multivariable logistic regression analysis. Male and bronchiectasis were protective factors. CONCLUSIONS: Discordant therapy was a cause of CF. Early accurate detection and management of prevention to potential causes is likely to improve clinical outcomes in elderly patients CAP. TRIAL REGISTRATION: A Retrospective Study on Hospitalized Patients With Community-acquired Pneumonia in China (CAP-China) (RSCAP-China), NCT02489578. Registered 16 March 2015, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0005E5S&selectaction=Edit&uid=U0000GWC&ts=2&cx=1bnotb.


Assuntos
Antibacterianos/uso terapêutico , Pneumonia Associada a Assistência à Saúde/diagnóstico , Pneumonia Associada a Assistência à Saúde/tratamento farmacológico , Pneumonia Associada a Assistência à Saúde/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Incidência , Masculino , Mortalidade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Falha de Tratamento
12.
Curr Med Res Opin ; 36(11): 1747-1752, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32986475

RESUMO

OBJECTIVE: Coronavirus disease 2019 (COVID-19) has high morbidity and mortality, and spreads rapidly in the community to result in a large number of infection cases. This study aimed to compare clinical features in adult patients with coronavirus disease 2019 (COVID-19) pneumonia to those in adult patients with community-acquired pneumonia (CAP). METHODS: Clinical presentations, laboratory findings, imaging features, complications, treatment and outcomes were compared between patients with COVID-19 pneumonia and patients with CAP. The study group of patients with COVID-19 pneumonia consisted of 120 patients. One hundred and thirty-four patients with CAP were enrolled for comparison. RESULTS: Patients with COVID-19 pneumonia had lower levels of abnormal laboratory parameters (white blood cell count, lymphocyte count, procalcitonin level, erythrocyte sedimentation rate and C-reactive protein level) and more extensive radiographic involvement. More severe respiratory compromise resulted in a higher rate of intensive care unit admission, acute respiratory distress syndrome (ARDS) and mechanical ventilation (36% vs 15%, 34% vs 15% and 32% vs 12%, respectively; all p < .05). The 30 day mortality was more than twice as high in patients with COVID-19 pneumonia (12% versus 5%; p = .063), despite not reaching a statistically significant difference. CONCLUSIONS: Lower levels of abnormal laboratory parameters, more extensive radiographic involvement, more severe respiratory compromise, and higher rates of ICU admission, ARDS and mechanical ventilation are key characteristics that distinguish patients with COVID-19-associated pneumonia from patients with CAP.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Adulto , Idoso , Estudos de Casos e Controles , China/epidemiologia , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/mortalidade , Infecções Comunitárias Adquiridas/terapia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença
13.
J Int Med Res ; 48(8): 300060520949039, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32865077

RESUMO

OBJECTIVE: This study was performed to investigate the clinical characteristics of patients with coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We analyzed the electronic medical records of 405 hospitalized patients with laboratory-confirmed COVID-19 in the Third Hospital of Wuhan. RESULTS: The patients' median age was 56 years, 54.1% were female, 11.4% had a history of smoking, and 10.6% had a history of drinking. All cases of COVID-19 were community-acquired. Fever (76.8%) and cough (53.3%) were the most common clinical manifestations, and circulatory system diseases were the most common comorbidities. Gastrointestinal symptoms were present in 61.2% of the patients, and 2.9% of the patients were asymptomatic. Computed tomography showed ground-glass opacities in most patients (72.6%) and consolidation in 30.9%. Lymphopenia (72.3%) and hypoproteinemia (71.6%) were observed in most patients. About 20% of patients had abnormal liver function. Patients with severe disease had significantly more prominent laboratory abnormalities, including an abnormal lymphocyte count and abnormal C-reactive protein, procalcitonin, alanine aminotransferase, aspartate aminotransferase, D-dimer, and albumin levels. CONCLUSION: SARS-CoV-2 causes a variety of severe respiratory illnesses similar to those caused by SARS-CoV-1. Older age, chronic comorbidities, and laboratory abnormalities are associated with disease severity.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/patologia , Gastroenteropatias/diagnóstico , Pneumonia Viral/diagnóstico , Pneumonia Viral/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Betacoronavirus , Proteína C-Reativa/análise , China , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/patologia , Infecções Comunitárias Adquiridas/virologia , Comorbidade , Infecções por Coronavirus/transmissão , Feminino , Gastroenteropatias/patologia , Gastroenteropatias/virologia , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/transmissão , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
14.
Pneumologie ; 74(8): 515-544, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32823360

RESUMO

The present guideline aims to improve the evidence-based management of children and adolescents with pediatric community-acquired pneumonia (pCAP). Despite a prevalence of approx. 300 cases per 100 000 children per year in Central Europe, mortality is very low. Prevention includes infection control measures and comprehensive immunization. The diagnosis can and should be established clinically by history, physical examination and pulse oximetry, with fever and tachypnea as cardinal features. Additional signs or symptoms such as severely compromised general condition, poor feeding, dehydration, altered consciousness or seizures discriminate subjects with severe pCAP from those with non-severe pCAP. Within an age-dependent spectrum of infectious agents, bacterial etiology cannot be reliably differentiated from viral or mixed infections by currently available biomarkers. Most children and adolescents with non-severe pCAP and oxygen saturation > 92 % can be managed as outpatients without laboratory/microbiology workup or imaging. Anti-infective agents are not generally indicated and can be safely withheld especially in children of young age, with wheeze or other indices suggesting a viral origin. For calculated antibiotic therapy, aminopenicillins are the preferred drug class with comparable efficacy of oral (amoxicillin) and intravenous administration (ampicillin). Follow-up evaluation after 48 - 72 hours is mandatory for the assessment of clinical course, treatment success and potential complications such as parapneumonic pleural effusion or empyema, which may necessitate alternative or add-on therapy.


Assuntos
Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Pneumonia/tratamento farmacológico , Guias de Prática Clínica como Assunto , Pneumologia/normas , Adolescente , Antibacterianos/administração & dosagem , Criança , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/virologia , Europa (Continente) , Alemanha , Humanos , Lactente , Pneumonia/diagnóstico , Pneumonia/virologia , Sociedades Médicas
15.
Eur Radiol ; 30(12): 6828-6837, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32683550

RESUMO

OBJECTIVE: To develop a fully automated AI system to quantitatively assess the disease severity and disease progression of COVID-19 using thick-section chest CT images. METHODS: In this retrospective study, an AI system was developed to automatically segment and quantify the COVID-19-infected lung regions on thick-section chest CT images. Five hundred thirty-one CT scans from 204 COVID-19 patients were collected from one appointed COVID-19 hospital. The automatically segmented lung abnormalities were compared with manual segmentation of two experienced radiologists using the Dice coefficient on a randomly selected subset (30 CT scans). Two imaging biomarkers were automatically computed, i.e., the portion of infection (POI) and the average infection HU (iHU), to assess disease severity and disease progression. The assessments were compared with patient status of diagnosis reports and key phrases extracted from radiology reports using the area under the receiver operating characteristic curve (AUC) and Cohen's kappa, respectively. RESULTS: The dice coefficient between the segmentation of the AI system and two experienced radiologists for the COVID-19-infected lung abnormalities was 0.74 ± 0.28 and 0.76 ± 0.29, respectively, which were close to the inter-observer agreement (0.79 ± 0.25). The computed two imaging biomarkers can distinguish between the severe and non-severe stages with an AUC of 0.97 (p value < 0.001). Very good agreement (κ = 0.8220) between the AI system and the radiologists was achieved on evaluating the changes in infection volumes. CONCLUSIONS: A deep learning-based AI system built on the thick-section CT imaging can accurately quantify the COVID-19-associated lung abnormalities and assess the disease severity and its progressions. KEY POINTS: • A deep learning-based AI system was able to accurately segment the infected lung regions by COVID-19 using the thick-section CT scans (Dice coefficient ≥ 0.74). • The computed imaging biomarkers were able to distinguish between the non-severe and severe COVID-19 stages (area under the receiver operating characteristic curve 0.97). • The infection volume changes computed by the AI system were able to assess the COVID-19 progression (Cohen's kappa 0.8220).


Assuntos
Betacoronavirus , Infecções Comunitárias Adquiridas/diagnóstico , Infecções por Coronavirus/diagnóstico , Aprendizado Profundo , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico , Pneumonia/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Inteligência Artificial , China/epidemiologia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Curva ROC , Estudos Retrospectivos
16.
Infection ; 48(6): 971-974, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32621281

RESUMO

PURPOSE: The first SARS-CoV-2 cases in Europe were reported in January 2020. Recently, concern arose on unrecognized infections before this date. For a better understanding of the pandemic, we retrospectively analyzed patient samples for SARS-CoV-2 from the prospective CAPNETZ study cohort. METHODS: We used nasopharyngeal swab samples from a cohort of well characterized patients with community acquired pneumonia of the CAPNETZ study group, recruited from different geographic regions across Germany, Austria, the Netherlands, and Switzerland between 02nd December 2019 and 28th April 2020. Multiplex real-time RT-PCR for a broad range of respiratory pathogens and SARS-CoV-2 real-time RT-PCR were performed on all samples. RESULTS: In our cohort, respiratory pathogens other than SARS-CoV-2 were detected in 21.5% (42/195) of patients with rhinovirus as the most frequently detected pathogen. The detection rate increased to 29.7% (58/195) when SARS-CoV-2 was included. No SARS-CoV-2 positive sample was detected before end of March 2020. CONCLUSIONS: Respiratory viral pathogens accounted for a considerable number of positive results but no SARS-CoV-2 case was identified before the end of March 2020.


Assuntos
/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Pneumonia/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , /virologia , Estudos de Coortes , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/etiologia , Infecções Comunitárias Adquiridas/história , Feminino , Alemanha , História do Século XXI , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Multiplex , Pneumonia/diagnóstico , Pneumonia/etiologia , Pneumonia/história , Adulto Jovem
17.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(7): 557-563, 2020 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-32629554

RESUMO

Objective: To describe the clinical characteristics and treatment of severe community-acquired pneumonia(SCAP) caused by Legionella pneumophila with acute respiratory failure and to analyze the risk factors for mortality. Methods: From October 2011 to October 2019, 34 patients were diagnosed with SCAP caused by Legionella pneumophila with acute respiratory failure.There were 25 males and 9 females, aged from 17 to 82 years, with a median age of 61 (48, 69) years. According to the prognosis, the patients were divided into a survival group and a death group for comparative analysis.The survival group included 24 patients, 17 males and 7 females, with a median age of 65 (55, 70) years. There were 10 cases in the death group, 8 males and 2 females, with a median age of 53 (50, 58) years. Multivariable logistic regression analysis was used for risk factors of ICU mortality. Results: The median time of admission to ICU was 7 (5, 11) days, the median time of stay in RICU was 12 (7, 22) days, and the PaO(2)/FiO(2) was 134 (91, 216) mmHg(1 mmHg=0.133 kPa). Ten patients died during ICU hospitalization, with a mortality of 29%. Sequential organ failure assessment (SOFA) of death group was 9 (7, 12), which was significantly higher than that of the survival group [4 (3, 8)], P=0.018. The time from onset of pneumonia symptoms to initiation of targeted treatment of the death group was 10 (7, 14) d, which was significantly longer than that of the survival group of [4 (3, 7) d], P=0.019. Multivariable logistic regression analysis showed that SOFA score (OR=1.461, 95%CI 1.041-2.051, P=0.028) and the time from onset of pneumonia symptoms to initiation of targeted treatment (OR=1.293, 95%CI 1.029-1.625, P=0.027) were independent risk factors for hospital mortality. Conclusions: The ICU mortality of severe legionella pneumonia was high. Critical organ dysfunctions and delayed initial targeted treatment were related with the increase of ICU mortality.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/diagnóstico , Pneumonia Bacteriana/diagnóstico , Insuficiência Respiratória , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/mortalidade , Infecções Comunitárias Adquiridas/terapia , Feminino , Humanos , Unidades de Terapia Intensiva , Doença dos Legionários/mortalidade , Doença dos Legionários/terapia , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/mortalidade , Prognóstico , Síndrome do Desconforto Respiratório do Adulto , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
18.
J Clin Pathol ; 73(12): 840-844, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32605920

RESUMO

Here, we report the pathological findings of nine complete autopsies of individuals who died in community settings in the UK, three of which were positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), three tested negative for SARS-CoV-2 but are likely false negatives, and three died of other respiratory infections. Autopsy revealed firm, consolidated lungs or lobar pneumonia. Histology of the lungs showed changes of diffuse alveolar damage with fibrin membrane formation, thickened alveolar walls and interstitium with lymphocytic infiltrate, and type 2 pneumocyte hyperplasia with shedding into the alveolar space. This series is the first in the world to describe autopsy findings in individuals dying suddenly in the community, not previously known to have COVID-19 infection, and the first autopsy series in the UK. During a time when testing in the UK is currently primarily offered to patients in hospital or symptomatic key workers, with limited testing available in community settings, it highlights the importance of testing for COVID-19 at autopsy. Two deaths occurred in care homes where a diagnosis of COVID-19 allowed the health protection team to provide support in that 'closed setting' to reduce the risks of onward transmission. This work highlights the need for frequent COVID-19 testing in the management of patients in community settings. Comprehensive virology and microbiology assessment is pivotal to correctly identify the cause of death, including those due to COVID-19 infection, and to derive accurate death statistics.


Assuntos
Autopsia , Pulmão/patologia , Miocárdio/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , /mortalidade , Causas de Morte , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/mortalidade , Infecções Comunitárias Adquiridas/patologia , Reações Falso-Positivas , Feminino , Humanos , Masculino , Reino Unido/epidemiologia
19.
Rev Esp Patol ; 53(3): 188-192, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32650970

RESUMO

The new coronavirus SARS-CoV-2, first identified in Wuhan, China in December, 2019, can cause Severe Acute Respiratory Syndrome (SARS) with massive alveolar damage and progressive respiratory failure. We present the relevant autopsy findings of the first patient known to have died from COVID19 pneumonia in Spain, carried out on the 14th of February, 2020, in our hospital (Hospital Arnau de Vilanova-Lliria, Valencia). Histological examination revealed typical changes of diffuse alveolar damage (DAD) in both the exudative and proliferative phase of acute lung injury. Intra-alveolar multinucleated giant cells, smudge cells and vascular thrombosis were present. The diagnosis was confirmed by reverse real-time PCR assay on a throat swab sample taken during the patient's admission. The positive result was reported fifteen days subsequent to autopsy.


Assuntos
Autopsia , Betacoronavirus , Infecções por Coronavirus/patologia , Pulmão/patologia , Pandemias , Pneumonia Viral/patologia , /etiologia , Idoso , Células Epiteliais Alveolares/ultraestrutura , Proteína 1 de Troca de Ânion do Eritrócito/análise , Antígenos CD/análise , Antígenos de Diferenciação Mielomonocítica/análise , Betacoronavirus/isolamento & purificação , Carcinoma de Células de Transição/complicações , China , Técnicas de Laboratório Clínico , Infecções Comunitárias Adquiridas/diagnóstico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Proteínas de Ligação a DNA/análise , Humanos , Pulmão/virologia , Macrófagos/química , Macrófagos/ultraestrutura , Masculino , Pneumonia/diagnóstico , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Espanha/epidemiologia , Fatores de Transcrição/análise , Viagem , Neoplasias da Bexiga Urinária/complicações
20.
MMWR Morb Mortal Wkly Rep ; 69(28): 918-922, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32678072

RESUMO

To limit introduction of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), the United States restricted travel from China on February 2, 2020, and from Europe on March 13. To determine whether local transmission of SARS-CoV-2 could be detected, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) conducted deidentified sentinel surveillance at six NYC hospital emergency departments (EDs) during March 1-20. On March 8, while testing availability for SARS-CoV-2 was still limited, DOHMH announced sustained community transmission of SARS-CoV-2 (1). At this time, twenty-six NYC residents had confirmed COVID-19, and ED visits for influenza-like illness* increased, despite decreased influenza virus circulation.† The following week, on March 15, when only seven of the 56 (13%) patients with known exposure histories had exposure outside of NYC, the level of community SARS-CoV-2 transmission status was elevated from sustained community transmission to widespread community transmission (2). Through sentinel surveillance during March 1-20, DOHMH collected 544 specimens from patients with influenza-like symptoms (ILS)§ who had negative test results for influenza and, in some instances, other respiratory pathogens.¶ All 544 specimens were tested for SARS-CoV-2 at CDC; 36 (6.6%) tested positive. Using genetic sequencing, CDC determined that the sequences of most SARS-CoV-2-positive specimens resembled those circulating in Europe, suggesting probable introductions of SARS-CoV-2 from Europe, from other U.S. locations, and local introductions from within New York. These findings demonstrate that partnering with health care facilities and developing the systems needed for rapid implementation of sentinel surveillance, coupled with capacity for genetic sequencing before an outbreak, can help inform timely containment and mitigation strategies.


Assuntos
Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/virologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Vigilância de Evento Sentinela , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/epidemiologia , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Análise de Sequência , Doença Relacionada a Viagens , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA