1/102. Community acquired pseudomonas aeruginosa pneumonia.pseudomonas aeruginosa is an uncommon cause of community acquired pneumonia in immunocompetent hosts. We report two cases that did well once appropriate and prolonged antimicrobial therapy was initiated. They had no evidence of immune deficiency. The initial consideration was pulmonary tuberculosis in both cases given the subacute presentation, significant weight loss, and findings on chest roentgenogram.- - - - - - - - - - ranking = 1keywords = pneumonia (Clic here for more details about this article) |
2/102. Fulminant psittacosis requiring mechanical ventilation and demonstrating serological cross-reactivity between legionella longbeachae and chlamydia psittaci.chlamydia psittaci infection typically causes a mild respiratory illness in humans. Severe respiratory failure requiring mechanical ventilation or intensive care therapy is an uncommon development. The aetiological agents causing severe community acquired pneumonia often remain undetermined. Serological tests may aid in diagnosis. We present two cases of fulminant psittacosis, one demonstrating early cross-reactivity with legionella longbeachae.- - - - - - - - - - ranking = 0.2keywords = pneumonia (Clic here for more details about this article) |
3/102. In-hospital management of adults who have community-acquired pneumonia.The initial in-hospital management of adult patients with community-acquired pneumonia can be divided into five major steps: an early recognition of the patient with presumptive pneumonia, assessment of the severity of illness, establishment of an etiologic diagnosis, supportive therapy, and decision regarding initiation of empirical therapy. In most European recommendations, the empirical antibiotic treatment is directed against "the most likely pathogen," based on epidemiological, clinical, and laboratory data, and on the severity of illness. In contrast, newer North American guidelines have focused on the severity of illness of community-acquired pneumonia. As a consequence, the use of a broader initial antibiotic coverage, including extended-spectrum cephalosporins and combinations, seems to be more common in north america than in europe.- - - - - - - - - - ranking = 1.4keywords = pneumonia (Clic here for more details about this article) |
4/102. Relapsing life threatening community acquired pneumonia due to rare Legionella species responsive to ceftriaxone and aztreonam.A 24 year old Saudi housewife was admitted thrice with life threatening community acquired pneumonia. Even though she responded to an initial cocktail of cefriaxone, erythromcin, rifampicin and flucloxacillin during the second admission, she relapsed within four days of discharge when she was on erythromycin only. During the third admission she was put on ceftriaxone and aztreonam and recovered fully without any relapse. serology results received later showed Legionella IgM titres of more than 1:256 for Legionella micdadei and Legionella bozemanii, and IgG titres of Legionella hackeliae. This case demonstrates relapsing pneumonia due to Legionella micdadei and bozemanii infection, and previous exposure to Legionella hackeliae. Both species, that is, Legionella micdadei and bozemanii, are resistant to erythromycin, but responded very well to a combination of ceftriaxone and aztreonam have not been used previously for the treatment of Legionnaires diseases.- - - - - - - - - - ranking = 1.2keywords = pneumonia (Clic here for more details about this article) |
5/102. Bacteremic pneumonia caused by a single clone of streptococcus pneumoniae with different optochin susceptibilities.Two isolates of streptococcus pneumoniae having different optochin susceptibilities were recovered from a blood sample of a 2-year-old boy with community-acquired pneumonia. The two isolates were documented to belong to a single clone on the basis of the isolates' identical serotype (23F), antibiograms by the E-test, random amplified polymorphic dna patterns generated by arbitrarily primed PCR, pulsed-field gel electrophoresis, and restriction fragment length polymorphism of the penicillin-binding protein genes pbp2b and pbp2x.- - - - - - - - - - ranking = 2keywords = pneumonia (Clic here for more details about this article) |
6/102. Mixed infection in adult bacterial meningitis.12 adult patients suffering from bacterial meningitis caused by mixed infection were identified at Kaohsiung Chang Gung Memorial Hospital over a period of 13 years (1986-1998), and they accounted for 6.5% (12/184) of our culture-proven adult bacterial meningitis. The 12 cases included seven males and five females, aged 17-74 years. Six of the 12 cases had community-acquired infections and the other six had nosocomially-acquired infections. Ten of the 12 cases had associated underlying diseases, with head trauma and/or neurosurgical procedure being the most frequent. Both gram-negative and gram-positive pathogens were identified in these 12 cases with gram-negative pathogens outnumbering the gram-positive ones. The implicated pathogens, starting with the most frequent, included Enterobacter species (enterobacter cloacae, enterobacter aerogenes), Klebsiella species (klebsiella pneumoniae, klebsiella oxytoca), escherichia coli, Staphylococcus species (staphylococcus aureus, staphylococcus haemolyticus), pseudomonas aeruginosa, acinetobacter baumannii, enterococcus, serratia marcescens, citrobacter diversus, proteus mirabilis, Streptococcus viridans and neisseria meningitidis. Six of the 12 cases were found to have multi-antibiotic-resistant strains, which included E. cloacae in one, A. baumannii in one, K. pneumoniae in one and S. aureus in three. The management of these 12 cases included appropriate antibiotics and neurosurgical procedures including shunt revision. Despite the complexity of implicated pathogens and the high incidence of emergence of resistant strains, the overall mortality rate (8.3%, 1/12) was not higher than that in adult bacterial meningitis. However, complete recuperation was difficult in adult patients with mixed bacterial meningitis.- - - - - - - - - - ranking = 0.4keywords = pneumonia (Clic here for more details about this article) |
7/102. Streptoccocus pyogenes: a forgotten cause of severe community-acquired pneumonia.We report a case of severe community-acquired pneumonia caused by streptococcus pyogenes (Lancefield Group A streptoccocus) that was complicated by a streptococcal toxic shock syndrome. Although this micro-organism is an uncommon cause of community-acquired pneumonia, previously well individuals may be infected and the clinical course may be fulminant. A household contact was the likely point of infection. Invasive group A streptococcal disease continues to remain an important cause of morbidity and mortality in the community and therefore will continue to be encountered by intensive care physicians. Treatment of Group A streptococcal infection remains penicillin; however, clindamycin should be added in severe infection.- - - - - - - - - - ranking = 1.2keywords = pneumonia (Clic here for more details about this article) |
8/102. A case of haemophilus parainfluenzae pneumonia.A 41 year old woman presented with community acquired pneumonia (CAP) which failed to resolve following treatment with amoxycillin and cefaclor prior to referral. Quantitative culture of sputum revealed a pure growth of haemophilus parainfluenzae and, following antibiotic susceptibility testing of the isolate, ciprofloxacin was prescribed resulting in resolution of the infection. Immunological investigations showed that the patient had a high titre of H parainfluenzae specific IgM. The combination of a pure growth of H parainfluenzae, a response to appropriate antimicrobial therapy, and the presence of a specific antibody response indicated that this organism had a pathogenic role in the patient's pneumonia and should be considered in the differential diagnosis of CAP.- - - - - - - - - - ranking = 1.2keywords = pneumonia (Clic here for more details about this article) |
9/102. Managing the nonsurgical candidate with an empyema related to community-acquired lobar pneumonia.This case study reviews the medical management for a 76-year-old patient with a cardiac history and recurrent admissions for a persistent pneumonia. Computed tomography showed evidence of an empyema in the right middle and lower lobes of his lung. The standard treatment for an empyema is a thoracotomy and long-term antibiotics. However, the patient's cardiac history disqualified surgery as an option. Therefore the management plan was composed of antibiotics and treatment of his symptoms. The patient's symptoms improved after a week of levofloxacin (Levaquin), prednisone, bilevel positive airway pressure mask as required, and oxygen. He was discharged with home care, oxygen, Levaquin, tapering doses of prednisone, and previous medications. At a 6-week follow-up examination, the patient was asymptomatic and had marked improvement noted on chest radiograph. The advanced practice nurse played an important role in this patient's recovery by conducting patient education and coordinating follow-up after his release.- - - - - - - - - - ranking = 1keywords = pneumonia (Clic here for more details about this article) |
10/102. Community-acquired pneumonia in adolescents.Community acquired pneumonia (CAP) is defined as pneumonia acquired outside of the hospital setting. Extensive studies of CAP in adolescents that characterize the true incidence of various etiologic pathogens are not available. However, streptococcus pneumoniae, mycoplasma pneumoniae, and chlamydia pneumoniae appear to be the most frequently encountered pathogens. These organisms often cause CAP in adults as well; other infections are noted as well, including Legionella. "Atypical pneumonia" refers to pneumonia not presenting with the usual clinical picture of pneumococcal infection (which includes high fever, productive cough, chills, and other "classic" features). The term is frequently used in adolescents with CAP. However, this classification may not help in individual patients, who often show a high degree of variability in the clinical presentation of pneumonia; also it does not always predict microbial cause. There is currently a trend away from the concept of atypical pneumonia syndrome and more discussion of atypical pathogens as commonly causes of CAP. This article reviews recent literature on CAP with special emphasis on its diagnosis and management in adolescent patients.- - - - - - - - - - ranking = 2.6keywords = pneumonia (Clic here for more details about this article) |
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