scholarly journals Candida Species in Community-Acquired Pneumonia in Patients With Chronic Aspiration

2021 ◽  
Author(s):  
Benjamin Joseph Moss ◽  
Daniel M. Musher
Keyword(s):  
Bacterial Pathogen ◽  
Clinical Information ◽  
Community Acquired Pneumonia ◽  
Gram Stain ◽  
Quantitative Culture ◽  
Convenience Sample ◽  
Etiologic Role ◽  
Large Numbers ◽  
Clinical Diagnoses ◽  
Anti Fungal

Abstract BackgroundWhen Candida is found in a sputum culture, clinicians generally dismiss it as a contaminant. We sought to identify cases of community-acquired pneumonia (CAP) in which Candida might play a contributory etiologic role.MethodsIn a convenience sample of patients hospitalized for CAP, we screened for “high-quality sputum” by Gram stain (>20 WBC/epithelial cell) and performed quantitative sputum cultures. Criteria for a potential etiologic role for Candida included the observation of large numbers of yeast forms on Gram stain and the finding of >106 CFU/ml Candida in sputum. We gathered clinical information on cases that met these criteria for possible Candida infection.ResultsSputum from 6 of 154 consecutive CAP patients had large numbers of extra- and intracellular yeast forms on Gram stain, with >106 CFU/ml Candida albicans, glabrata, or tropicalis on quantitative culture. In all 6 patients, the clinical diagnoses at admission included chronic aspiration. Greater than 105 CFU/ml of a recognized bacterial pathogen (Streptococcus pneumoniae, Staphylococcus aureus, or Pseudomonas) or >106 CFU/ml of other ‘normal respiratory flora’ (Lactobacillus species) were present together with Candida in every case. Blood cultures yielded Candida in 1 case, and 1,3-beta-D glucan was >500 ng/mL in 3 of 3 cases in which it was assayed. Since all patients were treated with anti-bacterial and anti-fungal drugs, no inference about etiology can be derived from therapeutic response.ConclusionsCandida species, together with a recognized bacterial pathogen or normal respiratory flora, may contribute to the cause of CAP in patients who chronically aspirate.

scholarly journals Candida species in community-acquired pneumonia in patients with chronic aspiration

Pneumonia ◽  
2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Benjamin J. Moss ◽  
Daniel M. Musher
Keyword(s):  
Therapeutic Response ◽  
Bacterial Pathogen ◽  
Clinical Information ◽  
Community Acquired Pneumonia ◽  
Gram Stain ◽  
Convenience Sample ◽  
Etiologic Role ◽  
Large Numbers ◽  
Clinical Diagnoses ◽  
Anti Fungal

Abstract Background When Candida species is found in a sputum culture, clinicians generally dismiss it as a contaminant. We sought to identify cases of community-acquired pneumonia (CAP) in which Candida might play a contributory etiologic role. Methods In a convenience sample of patients hospitalized for CAP, we screened for “high-quality sputum” by Gram stain (> 20 WBC/epithelial cell) and performed quantitative sputum cultures. Criteria for a potential etiologic role for Candida included the observation of large numbers of yeast forms on Gram stain, intracellular organisms and > 106 CFU/ml Candida in sputum. We gathered clinical information on cases that met these criteria for possible Candida infection. Results Sputum from 6 of 154 consecutive CAP patients had large numbers of extra- and intracellular yeast forms on Gram stain, with > 106 CFU/ml Candida albicans, glabrata, or tropicalis on quantitative culture. In all 6 patients, the clinical diagnoses at admission included chronic aspiration. Greater than 105 CFU/ml of a recognized bacterial pathogen (Streptococcus pneumoniae, Staphylococcus aureus, or Pseudomonas) or > 106 CFU/ml of other ‘normal respiratory flora’ (Lactobacillus species) were present together with Candida spp. in every case. Blood cultures yielded Candida in 2 cases, and 1,3-beta-D glucan was > 500 ng/mL in 3 of 3 cases in which it was assayed. Since all patients were treated with anti-bacterial and anti-fungal drugs, no inference about etiology can be derived from therapeutic response. Conclusions Candida spp. together with a recognized bacterial pathogen or normal respiratory flora may contribute to the cause of CAP in patients who chronically aspirate.

scholarly journals 2199. The Etiology of Community-Acquired Pneumonia with Attention to the Role of Normal Respiratory Flora

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S749-S749
Author(s):  
Daniel M Musher ◽  
Sirus Jesudasen ◽  
Joseph W Barwatt ◽  
Daniel N Cohen ◽  
Maria C Rodriguez-Barradas
Keyword(s):  
Medical Center ◽  
Sputum Sample ◽  
Community Acquired Pneumonia ◽  
Etiologic Agent ◽  
High Yield ◽  
Careful Study ◽  
Gram Stain ◽  
Upper Airways ◽  
Convenience Sample ◽  
Etiologic Role

Abstract Background Intensive studies have failed to identify an etiologic agent in >50% of patients (patients) who are hospitalized for community-acquired pneumonia (CAP). Gram stain and culture of sputum samples frequently yield “normal respiratory flora” (NRF). We hypothesized that careful study might (1) increase the yield of recognized pathogens; and (2) show, in some patients, an etiologic role for NRF. Methods We studied a convenience sample of adults hospitalized for CAP at a VA Medical Center if they met four criteria: (1) clinical syndrome consistent with pneumonia; (2) newly recognized pulmonary infiltrate; (3) sputum with > 10 WBC per epithelial cell; and (4) < 18 hours antibiotic treatment. For quantification of bacteria, sputum was liquefied in 2% N-acetyl cysteine and diluted serially. Other studies in nearly all patients included blood cultures, urine for pneumococcal (Spn) and Legionella antigen, procalcitonin, B-natriuretic protein and PCR for 13 respiratory viruses, Mycoplasma and Chlamydia. >106 bacteria/mL and a consistent Gram stain indicated a bacterial cause, positive viral PCR indicated a viral cause, and both indicated coinfection. Results 119 patients met study criteria. Recognized bacterial pathogens alone were identified in 47 (40%) cases led by Spn 17 (14%), Haemophilus 17 (14%) and S. aureus 6 (5%). A virus alone was identified in 17 (15%) and coinfection in 11 (9%). We applied these same criteria for NRF. NRF alone were found in 22 (19%) patients with S. mitis predominating. NRF and a respiratory virus were coinfecting in 10 (8%) patients. In total, with the inclusion of NRF, an etiologic agent was found in 95% of patients. Conclusion Our high yield is attributable to selection criteria. With a good-quality sputum and absent prolonged antibiotics, a bacterial cause for CAP was found in 59% of patients, a viral cause in 15%, and coinfection in 17%. Bacterial CAP due to recognized pathogen follows microaspiration of colonizing bacteria from the upper airways. Aspiration of a sufficient inoculum of so-called NRF, especially in older adults or those with damaged clearance mechanisms, might well do the same. Careful microbiologic study of patients who are able to provide a valid sputum sample before prolonged antibiotics enables a microbiologic diagnosis in nearly all cases and shows a potential etiologic role for NRF in about 20%. Disclosures All authors: No reported disclosures.

scholarly journals Major Adverse Cardiovascular Events During Invasive Pneumococcal Disease Are Serotype Dependent

2020 ◽  
Author(s):  
Hector F Africano ◽  
Cristian C Serrano-Mayorga ◽  
Paula C Ramirez-Valbuena ◽  
Ingrid G Bustos ◽  
Alirio Bastidas ◽  
...  
Keyword(s):  
Invasive Pneumococcal Disease ◽  
Pneumococcal Disease ◽  
Bacterial Pathogen ◽  
Retrospective Chart Review ◽  
Clinical Information ◽  
Major Adverse Cardiovascular Event ◽  
Community Acquired Pneumonia ◽  
Major Adverse Cardiovascular Events ◽  
Adverse Cardiovascular Event ◽  
Reactive Protein

Abstract Background Up to 30% of patients admitted to hospitals with invasive pneumococcal disease (IPD) experience major adverse cardiovascular event (MACE) including new/worsening heart failure, new/worsening arrhythmia, and/or myocardial infarction. Streptococcus pneumoniae (Spn) is the most frequently isolated bacterial pathogen among community-acquired pneumonia (CAP) patients and the only etiological agent linked independently to MACE. Nevertheless, no clinical data exist identifying which serotypes of Spn are principally responsible for MACE. Methods This was an observational multicenter retrospective study conducted through the Public Health Secretary of Bogotá, Colombia. We included patients with a confirmed clinical diagnosis of IPD with record of pneumococcal serotyping and clinical information between 2012 and 2019. Spn were serotyped using the quellung method by the National Center of Microbiology. MACE were determined by a retrospective chart review. Results The prevalence of MACE was 23% (71/310) in IPD patients and 28% (53/181) in patients admitted for CAP. The most prevalent S. pneumoniae serotype identified in our study was the 19A, responsible for the 13% (42/310) of IPD in our cohort, of which 21% (9/42) presented MACE. Serotypes independently associated with MACE in IPD patients were serotype 3 (odds ratio [OR] 1, 48; 95% confidence interval [CI] [1.21–2.27]; P = .013) and serotype 9n (OR 1.29; 95% CI [1.08–2.24]; P = .020). Bacteremia occurred in 87% of patients with MACE. Moreover, serum concentrations of C-reactive protein were elevated in patients with MACE versus in non-MACE patients (mean [standard deviation], 138 [145] vs 73 [106], P = .01). Conclusions MACE are common during IPD with serotype 3 and 9n independently of frequency.

Association of Genital Mycoplasmas with Exudative Vaginitis in a 10 Year Old: A Case of Misdiagnosis

PEDIATRICS ◽  
1983 ◽  
Vol 71 (2) ◽  
pp. 250-252
Author(s):  
K. B. Waites ◽  
M. B. Brown ◽  
S. Stagno ◽  
J. Schachter ◽  
S. Greenberg ◽  
...  
Keyword(s):  
Ureaplasma Urealyticum ◽  
Bacterial Pathogen ◽  
Mycoplasma Hominis ◽  
University Of Alabama ◽  
Large Numbers ◽  
Lower Genital Tract ◽  
History Of ◽  
The University ◽  
Urology Clinic ◽  
Multiple Antibiotics

A 10-year-old girl with a 1-year history of lower genitourinary tract symptoms suggestive of bacterial infection but with numerous negative urine cultures was referred to the University of Alabama urology clinic after empirical treatment with multiple antibiotics failed to resolve her symptoms. An extensive urologic evaluation revealed no structural or physiologic abnormalities, but an exudative vaginitis was noted and large numbers of Ureaplasma urealyticum and Mycoplasma hominis were isolated from the lower genital tract. Cultures for Chlamydia, viruses, and routine bacterial pathogens were negative. After initiation of tetracycline therapy, symptoms resolved and subsequent cultures for mycoplasmas were negative. In addition, a seroconversion was noted for M hominis but not for U urealyticum. Chlamydia serology was negative. It was later learned that the patient had been sexually molested just prior to the onset of symptoms. This case illustrates the necessity of early consideration of a mycoplasmal etiology in the patient with persistent genitourinary symptoms and no obvious bacterial pathogen, or in the patient whose condition is refractory to routine antibiotic therapy.

scholarly journals Usefulness of sputum gram stain for etiologic diagnosis in community-acquired pneumonia: a systematic review and meta-analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Gaspar Del Rio-Pertuz ◽  
Juan F. Gutiérrez ◽  
Abel J. Triana ◽  
Jorge L. Molinares ◽  
Andrea B. Robledo-Solano ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Community Acquired Pneumonia ◽  
Gram Stain ◽  
Etiologic Diagnosis

scholarly journals Potential of Minimally Invasive Tissue Sampling for Attributing Specific Causes of Childhood Deaths in South Africa: A Pilot, Epidemiological Study

2019 ◽  
Vol 69 (Supplement_4) ◽  
pp. S361-S373 ◽  
Author(s):  
Richard Chawana ◽  
Vicky Baillie ◽  
Alane Izu ◽  
Fatima Solomon ◽  
Quique Bassat ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Diarrheal Disease ◽  
Respiratory Infections ◽  
Clinical Information ◽  
International Classification Of Diseases ◽  
Community Acquired Pneumonia ◽  
Microbial Culture ◽  
Tissue Sampling ◽  
Classification Of Diseases ◽  
Syncytial Virus

Abstract Background Current estimates for causes of childhood deaths are mainly premised on modeling of vital registration and limited verbal autopsy data and generally only characterize the underlying cause of death (CoD). We investigated the potential of minimally invasive tissue sampling (MITS) for ascertaining the underlying and immediate CoD in children 1 month to 14 years of age. Methods MITS included postmortem tissue biopsies of brain, liver, and lung for histopathology examination; microbial culture of blood, cerebrospinal fluid (CSF), liver, and lung samples; and molecular microbial testing on blood, CSF, lung, and rectal swabs. Each case was individually adjudicated for underlying, antecedent, and immediate CoD by an international multidisciplinary team of medical experts and coded using the International Classification of Diseases, Tenth Revision (ICD-10). Results An underlying CoD was determined for 99% of 127 cases, leading causes being congenital malformations (18.9%), complications of prematurity (14.2%), human immunodeficiency virus/AIDS (12.6%), diarrheal disease (8.7%), acute respiratory infections (7.9%), injuries (7.9%), and malignancies (7.1%). The main immediate CoD was pneumonia, sepsis, and diarrhea in 33.9%, 19.7%, and 10.2% of cases, respectively. Infection-related deaths were either an underlying or immediate CoD in 78.0% of cases. Community-acquired pneumonia deaths (n = 32) were attributed to respiratory syncytial virus (21.9%), Pneumocystis jirovecii (18.8%), cytomegalovirus (15.6%), Klebsiella pneumoniae (15.6%), and Streptococcus pneumoniae (12.5%). Seventy-one percent of 24 sepsis deaths were hospital-acquired, mainly due to Acinetobacter baumannii (47.1%) and K. pneumoniae (35.3%). Sixty-two percent of cases were malnourished. Conclusions MITS, coupled with antemortem clinical information, provides detailed insight into causes of childhood deaths that could be informative for prioritization of strategies aimed at reducing under-5 mortality.

scholarly journals Community-Acquired Pneumonia in Children: Myths and Facts

2019 ◽  
Vol 36 (S 02) ◽  
pp. S54-S57 ◽  
Author(s):  
Ki Wook Yun ◽  
Rebecca Wallihan ◽  
Alexis Juergensen ◽  
Asuncion Mejias ◽  
Octavio Ramilo
Keyword(s):  
Respiratory Tract ◽  
Bacterial Infections ◽  
Pathogenic Bacteria ◽  
Bacterial Pathogen ◽  
Transcriptome Profiling ◽  
Antibiotic Use ◽  
Respiratory Viruses ◽  
Community Acquired Pneumonia ◽  
Prognostic Indicators ◽  
Upper Respiratory Tract

AbstractCommunity-acquired pneumonia (CAP) is the leading cause of death in children < 5 years of age worldwide. It is also one of the most frequent infectious diseases in children, leading to large antibiotic use and hospitalization even in the industrialized countries. However, the optimal management of CAP in children is still not well defined. Currently, respiratory viruses are considered the most frequent etiologic agents, but detection of viruses in the upper respiratory tract does not guarantee causation of pneumonia, nor precludes the presence of a bacterial pathogen. In both the upper and lower respiratory tract, respiratory viruses and pathogenic bacteria interact. Emerging evidence indicates that dual viral–bacterial infections function synergistically in many cases and together likely enhance the severity of CAP. Therefore, new and advanced technologies capable of sensitively and specifically discriminating viral, bacterial, and viral–bacterial coinfections are needed. Instead of focusing on the pathogen, analysis of host immune transcriptome profiles from children with CAP can potentially offer diagnostic signatures, help to assess disease severity, and eventually, prognostic indicators. An optimized management strategy by using molecular pathogen testing and transcriptome profiling will facilitate prompt, more appropriate, and targeted therapies, which in turn will lead to improved clinical outcomes in children with CAP.

Factors influencing the use of electronic health record systems to provide follow-up care to cancer survivors.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 182-182
Author(s):  
Guadalupe R. Palos ◽  
Maria Alma Rodriguez ◽  
Paula A. Lewis-Patterson ◽  
Rachel Harris ◽  
Lewis E. Foxhall
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Clinical Information ◽  
Primary Care Providers ◽  
Self Report ◽  
Care Providers ◽  
Convenience Sample ◽  
Major Barrier ◽  
Care Plans ◽  
Electronic Health

182 Background: One of the expected benefits of electronic health records (EHRs) is their interoperability to remotely access and exchange clinical information across systems and clinicians. Cancer survivors’ treatment summaries (TSs) and care plans (CPs) are documents that can be electronically transferred from oncologists to primary care providers. We conducted a needs assessment to identify factors which influenced EHRs in meeting these expectations in rural and underserved primary care settings. Methods: Clinicians from 2 family practice health care systems, located in central and northeast Texas were surveyed. REDCap, a web-based system, was used to develop, manage, and distribute the survey to a convenience sample of clinical staff from both settings. Survey questions focused on respondents’ demographic and clinical practice characteristics, current experience with TSs and CPs, and type of EHR used. Results: A total of 26 surveys were included in this analysis. Respondents were primarily physicians (73%). Overall 61.5% reported that ≤ 25% of their patients were diagnosed with cancer or currently had cancer. A patient’s self-report was the primary method used by majority of respondents to determine if a patient had a history of cancer. 80.8% indicated they would be interested in learning more about the use and development of TSs and CPs. Barriers reported towards the use of EHRs to deliver TSs and CPs included: EHRs interference with workflow (60%); limited knowledge on how to develop TSs and CPs (48%), inadequate access to IT resources (48%), and inefficient EHR systems (44%). In these settings, EHRs used were: Epic (61.6%), Aria (30.8%), and Medit (7.7%). Respondents’ comments on EHRs weaknesses included: “the two systems…do not completely communicate with each other” or “no place where a cancer treatment summary or survivorship plan is documented”. Conclusions: Primary care providers identified limitations in EHR operability as a major barrier to retrieving health information required for TSs and CPs. Clinicians in rural or underserved regions may benefit from education and retraining in EHR systems.

scholarly journals Critical Diagnoses in Ophthalmic Pathology: Suspected Important Unanticipated Diagnoses in Surgically Removed Eyes

2019 ◽  
Vol 6 (1) ◽  
pp. 44-49
Author(s):  
Curtis E. Margo
Keyword(s):  
Clinical Practice ◽  
Medical Care ◽  
Medical Records ◽  
Clinical Information ◽  
Critical Values ◽  
Care Providers ◽  
Request Form ◽  
Pathology Laboratory ◽  
Ophthalmic Pathology ◽  
Clinical Diagnoses

Aim: To describe the 5-year profile of anatomic critical diagnoses from an ophthalmic pathology laboratory and raise awareness of the challenges of establishing guidelines for these diagnoses. Methods: Medical records of patients who had consecutively submitted surgically removed globes or eviscerated eyes from 1 October 2009 to 31 October 2014 were examined for a critical diagnosis, as defined by a verbal communication for a serious, unanticipated diagnosis.Important discordant anatomic and clinical diagnoses were reviewed to determine whether the anatomic finding was truly unanticipated. Results: During the study period, 313 eyes were submitted to the laboratory as primary specimens. Twenty (6.4%) had critical (alert) diagnoses. Six of the 20 anatomic diagnoses (30%) were known or suspected prior to surgery but were not communicated on the pathology request form. Five diagnoses (25%) were not clinically suspect before surgery. In 9 cases (45%) medical-care providers were alerted to the critical findings but insufficient clinical information was provided about preoperative conditions. Conclusions: The proportion of critical diagnoses among surgically removed eyes is small, but not inconsequential. Some “critical alerts” would be unnecessary if relevant clinical information was provided when the tissue is submitted to the laboratory. Laboratory guidelines for critical values in surgical pathology should be flexible since they need to anticipate the vicissitudes of clinical practice. Surgeons need to appreciate that relevant clinical information must be provided to pathologists because it can play a role in formulating anatomic diagnoses.

365: Utility of Sputum Gram Stain for Community-Acquired Pneumonia at the Emergency Department

2010 ◽  
Vol 56 (3) ◽  
pp. S118
Author(s):  
C. Ferre ◽  
F. Llopis ◽  
J. Jacob ◽  
A. Juan ◽  
X. Corbella ◽  
...  
Keyword(s):  
Emergency Department ◽  
Community Acquired Pneumonia ◽  
Gram Stain
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