scholarly journals Current perspectives on atypical pneumonia in children

2020 ◽  
Vol 63 (12) ◽  
pp. 469-476 ◽  
Author(s):  
Jung Yeon Shim
Keyword(s):  
Legionella Pneumophila ◽  
Cell Walls ◽  
Point Mutations ◽  
Chlamydophila Pneumoniae ◽  
Community Acquired Pneumonia ◽  
Atypical Pneumonia ◽  
First Line ◽  
Inflammatory Status ◽  
Major Pathogens ◽  
Japan And China

The major pathogens that cause atypical pneumonia are <i>Mycoplasma pneumoniae, Chlamydophila pneumoniae</i>, and <i>Legionella pneumophila</i>. Community-acquired pneumonia (CAP) caused by <i>M. pneumoniae</i> or <i>C. pneumoniae</i> is common in children and presents as a relatively mild and self-limiting disease. CAP due to <i>L. pneumophila</i> is very rare in children and progresses rapidly, with fatal outcomes if not treated early. <i>M. pneumoniae, C. pneumoniae</i>, and <i>L. pneumophila</i> have no cell walls; therefore, they do not respond to β-lactam antibiotics. Accordingly, macrolides, tetracyclines, and fluoroquinolones are the treatments of choice for atypical pneumonia. Macrolides are the first-line antibiotics used in children because of their low minimum inhibitory concentrations and high safety. The incidence of pneumonia caused by macrolide-resistant <i>M. pneumoniae</i> that harbors point mutations has been increasing since 2000, particularly in Korea, Japan, and China. The marked increase in macrolide-resistant <i>M. pneumoniae</i> pneumonia (MRMP) is partly attributed to the excessive use of macrolides. MRMP does not always lead to clinical nonresponsiveness to macrolides. Furthermore, severe complicated MRMP responds to corticosteroids without requiring a change in antibiotic. This implies that the hyper-inflammatory status of the host can induce clinically refractory pneumonia regardless of mutation. Empirical macrolide therapy in children with mild to moderate CAP, particularly during periods without <i>M. pneumoniae</i> epidemics, may not provide additional benefits over β-lactam monotherapy and can increase the risk of MRMP.

scholarly journals Detection of Atypical Pathogens in Community Acquired Pneumonia by Indirect Immunofluorescence Assay

2021 ◽  
Author(s):  
Partha Guchhait ◽  
Doddarangappa Rangaswamy Gayathri Devi ◽  
VA Indumathi ◽  
TS Deepak
Keyword(s):  
Streptococcus Pneumoniae ◽  
Haemophilus Influenzae ◽  
Mycoplasma Pneumoniae ◽  
Indirect Immunofluorescence ◽  
Legionella Pneumophila ◽  
Immunofluorescence Assay ◽  
Community Acquired Pneumonia ◽  
Indirect Immunofluorescence Assay ◽  
Atypical Pneumonia ◽  
Atypical Pathogens

Introduction: Community Acquired Pneumonia (CAP), as the name suggests, is acquired at the community level, and symptoms usually develop within 48 hours. There are two types of CAP, namely, typical and atypical. Typical pneumonia is usually caused by bacteria such as Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. Atypical pneumonia is caused by Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella pneumophila, and Coxiella burnetii, as well as respiratory viruses, such as Adenovirus, Respiratory Syncytial Virus (RSV), Influenza viruses A and B, and Parainfluenza viruses 1,2,3, among others. Typical and atypical CAP can be distinguished by the absence or presence of extrapulmonary symptoms. Aim: To elucidate the proportion of atypical respiratory pathogens that cause CAP in a tertiary care hospital setting. Materials and Methods: This was a cross-sectional study that was conducted at the Department of Medicine, Chest Medicine and Microbiology of MS Ramaiah Medical College, Bengaluru, Karnataka, India. The study included 202 patients, aged 18 years and above with clinical and radiological features of CAP. Indirect Immunofluorescence Assay (IFA) was carried out to detect the pathogens. Results: The prevalence of atypical pathogens was 33.17% among all CAP patients. Atypical pneumonia was more prevalent in males and in the age group of >61 years. The most common pathogens included Mycoplasma pneumoniae (12.38%) followed by Legionella pneumophila (9.90%) and influenza A (5.94%). Typical pneumonia was primarily caused by Streptococcus pneumoniae (9.9%), followed by Klebsiella pneumoniae (1.49%), Staphylococcus aureus (1.49%), and Haemophilus influenzae (0.49%). Mixed infections occurred in 16 patients. Conclusion: Active screening for CAP is needed in all wards and Intensive Care Units (ICU), as more patients with CAP are increasingly being admitted to ICU. Data on the proportion of atypical CAP will help to use antibiotics prudently for a better prognosis, thereby preventing the emergence of antibiotic resistance.

scholarly journals 66. Impact of a Pharmacist-Driven Azithromycin De-escalation Protocol for Community-Acquired Pneumonia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S52-S52
Author(s):  
Pegah Shakeraneh ◽  
Jeffrey Steele ◽  
Robert Seabury ◽  
Stephen J Thomas ◽  
Kristopher M Paolino ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Panel Member ◽  
Community Acquired Pneumonia ◽  
Hospital Length Of Stay ◽  
Post Intervention ◽  
Review Panel ◽  
Icu Patients ◽  
Significant Difference ◽  
Atypical Bacteria ◽  
Research Grant

Abstract Background Ceftriaxone and azithromycin are common empiric antibiotics for community-acquired pneumonia (CAP). Despite low suspicion for atypical infection, azithromycin is often continued for a full course. Negative laboratory data for atypical bacteria may assist with azithromycin de-escalation. Thus, a pharmacist-driven azithromycin de-escalation protocol was implemented for immunocompetent, non-intensive care unit (ICU) patients treated for CAP. The primary outcome was to compare azithromycin duration before and after protocol implementation. Secondary outcomes included hospital length of stay (LOS) and all-cause 30-day readmission. Methods This was a single-center, quasi-experimental study of hospitalized, non-ICU patients treated with azithromycin and a beta-lactam for CAP. The pre- and post-intervention cohorts were from 07/01/2018–04/30/2019 and 07/01/2019–04/30/2020, respectively. Patients were included if they were ≥18 years old, diagnosed with CAP, and had a negative Legionella pneumophila urinary antigen and negative nasopharyngeal swab PCR for Mycoplasma pneumoniae and Chlamydia pneumoniae. Patients were excluded if they were immunocompromised, admitted to an ICU, prescribed azithromycin for an alternative indication, or had evidence of atypical bacteria. Results After exclusion criteria were applied, 90 and 100 patients were included in the pre- and post-intervention cohorts, respectively. Demographic and clinical characteristics were mostly similar between cohorts. This initiative was associated with a statistically significant decrease in azithromycin duration (2 days (IQR 1–2.75) vs. 5 days (IQR 3–6), p &lt; 0.001) and hospital LOS (3 days (IQR 2–5) vs. 5 days (IQR 3–8.25), p &lt; 0.001). No statistically significant difference was observed for all-cause 30-day readmission (14 days (15.6%) vs 13 days (13.0%), p=0.614). Conclusion Implementation of a pharmacist-driven azithromycin de-escalation protocol for CAP was associated with reduced azithromycin duration and hospital LOS, but not all-cause 30-day readmission. Disclosures Jeffrey Steele, PharMD, Paratek Pharmaceuticals (Advisor or Review Panel member) Wesley D. Kufel, PharmD, Melinta (Research Grant or Support)Merck (Research Grant or Support)Theratechnologies, Inc. (Advisor or Review Panel member)

scholarly journals Peptidyl-Prolyl-cis/trans-Isomerases Mip and PpiB ofLegionella pneumophilaContribute to Surface Translocation, Growth at Suboptimal Temperature, and Infection

2018 ◽  
Vol 87 (1) ◽  
Author(s):  
J. Rasch ◽  
C. M. Ünal ◽  
A. Klages ◽  
Ü. Karsli ◽  
N. Heinsohn ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Acanthamoeba Castellanii ◽  
Temperature Tolerance ◽  
Lung Damage ◽  
Atypical Pneumonia ◽  
Content Type ◽  
Wide Range ◽  
Legionnaires Disease ◽  
Environmental Fitness ◽  
Sliding Motility

ABSTRACTThe gammaproteobacteriumLegionella pneumophilais the causative agent of Legionnaires’ disease, an atypical pneumonia that manifests itself with severe lung damage.L. pneumophila, a common inhabitant of freshwater environments, replicates in free-living amoebae and persists in biofilms in natural and man-made water systems. Its environmental versatility is reflected in its ability to survive and grow within a broad temperature range as well as its capability to colonize and infect a wide range of hosts, including protozoa and humans. Peptidyl-prolyl-cis/trans-isomerases (PPIases) are multifunctional proteins that are mainly involved in protein folding and secretion in bacteria. InL. pneumophilathe surface-associated PPIase Mip was shown to facilitate the establishment of the intracellular infection cycle in its early stages. The cytoplasmic PpiB was shown to promote cold tolerance. Here, we set out to analyze the interrelationship of these two relevant PPIases in the context of environmental fitness and infection. We demonstrate that the PPIases Mip and PpiB are important for surfactant-dependent sliding motility and adaptation to suboptimal temperatures, features that contribute to the environmental fitness ofL. pneumophila. Furthermore, they contribute to infection of the natural hostAcanthamoeba castellaniias well as human macrophages and human explanted lung tissue. These effects were additive in the case of sliding motility or synergistic in the case of temperature tolerance and infection, as assessed by the behavior of the double mutant. Accordingly, we propose that Mip and PpiB are virulence modulators ofL. pneumophilawith compensatory action and pleiotropic effects.

scholarly journals Antibiotic Prescribing for Adults Hospitalized in the Etiology of Pneumonia in the Community Study

2017 ◽  
Vol 4 (2) ◽  
Author(s):  
Sara Tomczyk ◽  
Seema Jain ◽  
Anna M Bramley ◽  
Wesley H Self ◽  
Evan J Anderson ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Community Study ◽  
Antibiotic Prescribing ◽  
Beta Lactam ◽  
First Line ◽  
Factors Associated ◽  
Admission Ward ◽  
Healthcare Associated ◽  
To Receive

Abstract Background Community-acquired pneumonia (CAP) 2007 guidelines from the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) recommend a respiratory fluoroquinolone or beta-lactam plus macrolide as first-line antibiotics for adults hospitalized with CAP. Few studies have assessed guideline-concordant antibiotic use for patients hospitalized with CAP after the 2007 IDSA/ATS guidelines. We examine antibiotics prescribed and associated factors in adults hospitalized with CAP. Methods From January 2010 to June 2012, adults hospitalized with clinical and radiographic CAP were enrolled in a prospective Etiology of Pneumonia in the Community study across 5 US hospitals. Patients were interviewed using a standardized questionnaire, and medical charts were reviewed. Antibiotics prescribed were classified according to defined nonrecommended CAP antibiotics. We assessed factors associated with nonrecommended CAP antibiotics using logistic regression. Results Among enrollees, 1843 of 1874 (98%) ward and 440 of 446 (99%) ICU patients received ≥1 antibiotic ≤24 hours after admission. Ward patients were prescribed a respiratory fluoroquinolone alone (n = 613; 33%), or beta-lactam plus macrolide (n = 365; 19%), beta-lactam alone (n = 240; 13%), among other antibiotics, including vancomycin (n = 235; 13%) or piperacillin/tazobactam (n = 157; 8%) ≤24 hours after admission. Ward patients with known risk for healthcare-associated pneumonia (HCAP), recent outpatient antibiotic use, and in-hospital antibiotic use &lt;6 hours after admission were significantly more likely to receive nonrecommended CAP antibiotics. Conclusions Although more than half of ward patients received antibiotics concordant with IDSA/ATS guidelines, a number received nonrecommended CAP antibiotics, including vancomycin and piperacillin/tazobactam; risk factors for HCAP, recent outpatient antibiotic, and rapid inpatient antibiotic use contributed to this. This hypothesis-generating descriptive epidemiology analysis could help inform antibiotic stewardship efforts, reinforces the need to harmonize guidelines for CAP and HCAP, and highlights the need for improved diagnostics to better equip clinicians.

scholarly journals Community-acquired pneumonia due to Legionella pneumophila, the utility of PCR, and a review of the antibiotics used

2011 ◽  
pp. 15 ◽  
Author(s):  
Paul Zarogoulidis ◽  
Gioulia Romanidou ◽  
EIRINI TERZI ◽  
Kostas Zarogoulidis ◽  
Ioanna Alexandropoulou
Keyword(s):  
Legionella Pneumophila ◽  
Community Acquired Pneumonia

scholarly journals Antimicrobial activity of the volatile phase of essential oils and their constituents on Legionella pneumophila

2020 ◽  
Vol 14 (1) ◽  
pp. 54-61
Author(s):  
Lucia Bićanić ◽  
Silvestar Mežnarić ◽  
Ivana Gobin
Keyword(s):  
Essential Oil ◽  
Essential Oils ◽  
Legionella Pneumophila ◽  
Pathogenic Bacteria ◽  
Antimicrobial Properties ◽  
Model Organism ◽  
Public Health Problem ◽  
Volatile Components ◽  
Atypical Pneumonia ◽  
Pontiac Fever

Abstract Pathogenic bacteria of the genus Legionella cause atypical pneumonia known as Legionnaires’ disease and flu – like disease known as Pontiac fever. As pathogens of the respiratory system, these bacteria represent a public health problem and there is a need for examine new alternative ways to inactivate them. These bacteria live naturally in water and are transmitted by infectious aerosols. To purify the air, essential oils that show antimicrobial properties are widely used. The anti-Legionella activity of five exotic essential oils and five Mediterranean essential oils characteristic for coastal Croatia was examined. Model organism used in experiments was L. pneumophila (strain 130b). This experiment was conducting with modified version of sealed plate method using a BCYE medium. The exotic essential oil with highest anti-Legionella activity was Niaouli essential oil, and the best anti-Legionella activity among Mediterranean essential oils showed Immortelle essential oil. Anti- Legionella activity of four main chemical compounds was examined and compound that show significant highest anti-Legionella activity was α – pinene. Volatile components of essential oils have a great potential as anti-Legionella agents and further research are needed.

scholarly journals Community-acquired pneumonia in children – problems and solutions

2021 ◽  
Vol 66 (1) ◽  
pp. 9-21
Author(s):  
V. K. Tatochenko
Keyword(s):  
Pulmonary Infiltrate ◽  
Community Acquired Pneumonia ◽  
Atypical Pneumonia ◽  
Contributing Factors ◽  
X Ray ◽  
High Doses ◽  
Severity Of The Disease ◽  
Unclear Etiology ◽  
High Level

Pneumonia in children remains one of the most serious diseases. Despite intensive study, the diagnosis and treatment still present a variety of problems. The article is aimed to identify these problems and show the ways of their solution.One of the criteria for the diagnosis of pneumonia is pulmonary infiltrate on the X-ray image. Community-acquired pneumonia is often caused by Pneumococci and mycoplasma; respiratory viruses, influenza usually serve as contributing factors for bacterial infection. The high level of hyperand underdiagnosis of community-acquired pneumonia is associated with its similarity with ARVI; the registration of general violations (signs of the severity of the disease) improves the quality of diagnosis. The clinical and radiological picture helps to distinguish pneumococcal pneumonia from pneumonia caused by mycoplasma. To improve the diagnosis of community-acquired pneumonia, it is necessary to study inflammation markers during the first examination of the patient, which is impossible in the conditions of home care. Due to the growth of resistance of pneumococci to macrolides a community-acquired pneumonia of pneumococcal (and unclear) etiology requires the use of amoxicillin in high doses and macrolides (in case of atypical pneumonia). Gentle therapy of destructive pneumonia, steroids for metapneumonic pleurisy allow avoiding invasive interventions and help to repair lung tissue.

scholarly journals Mutations in domain V of Mycoplasma pneumoniae 23S rRNA are not associated with clinical characteristics of M. pneumoniae pneumonia in children: a case control study

2020 ◽  
Author(s):  
Huan Deng ◽  
Yifan Zhu ◽  
Jiamin Zhang ◽  
Qiangquan Rong ◽  
Yao Quan ◽  
...  
Keyword(s):  
Mycoplasma Pneumoniae ◽  
Lymphocyte Count ◽  
Clinical Characteristics ◽  
Clinical Symptoms ◽  
Laboratory Data ◽  
Point Mutations ◽  
Community Acquired Pneumonia ◽  
Pulmonary Complications ◽  
23S Rrna ◽  
Domain V

Abstract Background Mycoplasma pneumoniae (MP) is a common agent of community-acquired pneumonia in children and young adults that can lead to refractory or persistent Mycoplasma pneumoniae pneumonia (MPP). Macrolide-resistant MP harbors point mutations in domain V of 23S ribosomal Ribonucleic Acid (rRNA) with substitutions detected at positions 2063, 2064, 2067 and 2617. This study’s purpose is to investigate the prevalence and clinical characteristics of mutations in domain V of MP 23S rRNA. Methods We sequenced the 23S rRNA domain V of MP strains collected from children with MPP. Clinical and laboratory data were also obtained, including gender, age, duration of fever, duration of fever after the start of macrolide therapy, MP-Deoxyribonucleic Acid (DNA) load at enrollment, leukocyte count, neutrophil count, and lymphocyte count, immunomodulators treatment and pulmonary complications.Results Of 276 strains, 255 (92.39 %) harbored A to G transition at the position 2063 (A2063G), and 21 (7.61 %) were not mutated. There were no significant differences in gender, age, duration of fever, duration of fever after the start of macrolide therapy, MP-DNA load at enrollment, hospitalization days, lymphocyte count and pulmonary complications when patients were stratified based on the presence or absence of domain V mutations. We also found that children with refractory MPP experienced higher MP-DNA load than the non-refractory MPP, but the prevalence of domain V mutations was comparable.Conclusions We found that clinical MP strains harbored very high mutation rate in 23S rRNA domain V, especially A2063G mutation. However, these mutations were not associated with clinical symptoms, laboratory results, pulmonary complications and development of refractory pneumonia. Instead, MP-DNA load was significantly different between refractory and non-refractory MPP.

Sign in / Sign up

Export Citation Format

Share Document