Pneumonia

For 3 days, a 45-year-old woman with HIV infection who was noncompliant with her antiretroviral medications had cough, yellowish sputum, fever, and dyspnea. She denied hemoptysis, weight loss, or recent hospitalization. She had a long history of heavy smoking and alcohol and intravenous drug abuse.

New guidelines for community-acquired pneumonia (CAP) issued jointly by the Infectious Diseases Society of America and the American Thoracic Society emphasize the need for communities to adapt the recommendations to local conditions.

Given the dramatic advances in antimicrobials since penicillin was introduced, why has the mortality rate associated with community-acquired pneumonia (CAP) remained essentially unchanged?

SAN DIEGO -- Rushing the decision to treat suspected pneumonia with antibiotics may lead to unnecessary treatment in a majority of cases, according to a small study reported here.

SAN DIEGO -- A potentially deadly form of community-acquired pneumonia linked to adenovirus type 14 has emerged in the Pacific northwest, according to a report presented here.

EDMONTON, Alberta -- Pneumococcal vaccine dose not prevent community-acquired pneumonia but can significantly reduce deaths or ICU admissions from it, researchers here reported.

Congestive heart failure and cirrhosis are the most common causes of transudative pleural effusions, while pneumonia and malignancy are responsible for the majority of exudative effusions. Plain chest films are valuable in confirming the presence of an effusion, providing clues to the cause, and directing the method of pleural fluid sampling. Thoracentesis is safe and simple, and it is diagnostic in about 75% of cases. Pleural biopsy is indicated for unexplained exudative effusions, most of which are found to result from malignancy or tuberculosis. Medical thoracoscopy, if available, is the procedure of choice for patients with these effusions. Thoracoscopy permits visually directed pleural biopsies and allows for therapeutic intervention at the time of diagnosis, obviating the need for subsequent invasive procedures.

abstract: While the risk factors for aspiration pneumonia are similar to those for aspiration pneumonitis, the 2 syndromes have different presentations. Aspiration pneumonia tends to occur in older patients or in those with neurological diseases, and the aspiration is not usually witnessed. Aspiration pneumonitis is more likely to occur in patients undergoing anesthesia or in those with acute drug and alcohol overdoses, and the aspiration is often witnessed. The workup may include bedside assessment of the cough and gag reflexes, chest radiography, videofluoroscopic imaging, or fiberoptic endoscopy. Empiric antibiotic therapy should be avoided in most patients with pneumonitis; however, antibiotics may be indicated for those at high risk for bacterial colonization of oropharyngeal and gastric contents who have fever, increasing sputum production, or new infiltrates or for those who fail to improve within 48 hours. (J Respir Dis. 2007;28(9):370-385)

The patient described here was treated for pneumonia, but a chest wall mass and CT changes suggested that more was going on.

PITTSBURGH -- Fatal sepsis in hospitalized pneumonia patients is most likely to occur in the presence of high levels of certain proinflammatory and anti-inflammatory cytokines, investigators here found.