Role of the inflammatory response in community-acquired pneumonia: clinical implications.

Role of the inflammatory response in community-acquired pneumonia: clinical implications. Expert Rev Anti Infect Ther. 2020 Oct 09;: Authors: Rombauts A, Abelenda-Alonso G, Cuervo G, Gudiol C, Carratalà J Abstract INTRODUCTION: Despite adequate antibiotic coverage, community-acquired pneumonia (CAP) remains a leading cause of hospitalization and mortality worldwide. It induces both a local pulmonary and a systemic inflammatory response, particularly significant in severe cases. The intensity of the dysregulated host response varies from patient to patient and has a negative impact on survival and other outcomes. AREAS COVERED: This comprehensive review summarizes the pathophysiological aspects of the inflammatory response in CAP, briefly discusses the usefulness of biomarkers, and assesses the clinical evidence for modulating the inflammatory pathways. We searched PubMed for the most relevant studies, reviews and meta-analysis until August 2020. EXPERT OPINION: Notable efforts have been made to identify biomarkers that can accurately differentiate between viral and bacterial etiology, and indeed, to enhance risk stratification in CAP. However, none has proven ideal and no recommended biomarker-guided algorithms exist. Biomarker signatures from proteomic and metabolomic studies could be more useful for such assessments. To date, most studies have produced contradictory results concerning the role of immunomodulatory agents (e.g., corticoster...
Source: Expert Review of Anti-Infective Therapy - Category: Infectious Diseases Tags: Expert Rev Anti Infect Ther Source Type: research

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AbstractWith the expanding use of molecular assays, viral pathogens are increasingly recognized among critically ill adult patients with community-acquired severe respiratory illness; studies have detected respiratory viral infections (RVIs) in 17 –53% of such patients. In addition, novel pathogens including zoonotic coronaviruses like the agents causing Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) and the 2019 novel coronavirus (2019 nCoV) are still being identified. Patients with severe RVIs requiring ICU care present typically with hypoxemic respiratory failure. Oseltamivir is ...
Source: Intensive Care Medicine - Category: Intensive Care Source Type: research
Authors: Garnacho-Montero J, Barrero-García I, Gómez-Prieto MG, Martín-Loeches I Abstract INTRODUCTION: Despite advances in modern medicine, severe community-acquired pneumonia (CAP) continues to be a potentially deadly disease. Mortality rate reaches up to the 50% in patients requiring admission to the Intensive Care Unit (ICU) when developing septic shock. Areas covered: We aim to describe the optimal management of severe CAP including antibiotic therapy, future antimicrobial options, and non-antibiotic (so-called adjunctive) therapies. A literature search was performed to identify all clinic...
Source: Expert Review of Anti-Infective Therapy - Category: Infectious Diseases Tags: Expert Rev Anti Infect Ther Source Type: research
​BY AN​UMEHA SINGH, MDA 56-year-old man presented to the ED with shortness of breath and pleural effusions diagnosed by an outside treating physician. The workup included urinalysis, which showed proteinuria, and the exam was consistent with myxedema and pedal edema. He had a history of rheumatoid arthritis, leukocytoclastic vasculitis and Sjögren's syndrome, diabetes, and monoclonal gammopathy of unknown significance (MGUS).The patient also had shortness of breath for a month and pleural effusions on outpatient chest x-ray. He had taken Humira, methotrexate (MTX), and steroids, but his arthritis and Sjögren'...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
​BY ANDRZEJ KIELTYKA, PA; PARDEEP THANDI, MD; &ANUMEHA SINGH, MDA 56-year-old man presented to the emergency department with shortness of breath for one month and pleural effusions on an outpatient chest x-ray. He had been taking adalimumab, methotrexate, and steroids for arthritis and Sjogren's syndrome.A right pleural effusion in a patient with nephrotic syndrome.His monoclonal gammopathy of undetermined significance (MGUS) was monitored annually, but no medical intervention beyond surveillance was required. He had excessive thirst but normal urine output. He noted face and hand swelling in the morning that gave wa...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
Semin Respir Crit Care Med 2016; 37: 913-922 DOI: 10.1055/s-0036-1593538Community-acquired pneumonia (CAP) is a leading cause of hospitalization, morbidity, and mortality. Despite advances in antibiotic treatments, mortality among patients with CAP is still high. For this reason, interest has been focused on nonantibiotic therapeutic measures directed to the host response rather than the microorganism. The development of an efficacious adjunctive treatment has important implications for reducing mortality in CAP. Some clinical studies performed in the last decade have shown a clinically beneficial effect of corticosteroids...
Source: Seminars in Respiratory and Critical Care Medicine - Category: Respiratory Medicine Authors: Tags: Review Article Source Type: research
Conclusion: SILD may mimic various lung diseases, leading to misdiagnosis and inappropriate approach. Statins are widely prescribed drugs and physicians should be aware of possible side-effects.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: 1.5 Diffuse Parenchymal Lung Disease Source Type: research
Purpose of review: Describe recent studies that may impact on the management of community-acquired pneumonia (CAP). Recent findings: CAP continues to be associated with a considerable burden of disease. Diagnosis remains problematic, and various biomarkers are neither accurate in the diagnosis of the presence of CAP nor superior to standard severity of illness scores in predicting outcome. Current evidence indicates that patients with nonsevere CAP can be effectively treated with antibiotic monotherapy, whereas those with severe infection, particularly ICU cases, do best with early initiation of combination antibiotic the...
Source: Current Opinion in Critical Care - Category: Nursing Tags: INFECTIOUS DISEASES: Edited by Tobias Welte Source Type: research
SPECIAL FROM Next Avenue By Craig Bowron As we head into the New Year, let’s take a look back and see what lessons we should have learned from medical science in 2015. The New England Journal of Medicine’s publication Journal Watch provides physicians and other health care providers with expert analysis of the most recent medical research. Below is a brief synopsis of what the Journal Watch editors felt were the most important stories in general medicine for the year 2015. While you likely heard about a couple, others probably escaped your radar. Getting Aggressive with Strokes We’re familiar with the id...
Source: Science - The Huffington Post - Category: Science Source Type: news
Publication date: Available online 1 October 2015 Source:New Horizons in Translational Medicine Author(s): Jimstan Periselneris, Ricardo J. José, Jeremy Brown . Streptococcus pneumoniae is a common cause of infectious morbidity and mortality, causing otitis media, pneumonia, septicaemia, and meningitis. The host inflammatory response is required for clearance of bacteria, but excessive inflammation can mediate bystander tissue damage. The host response is complex; involving initial recognition by pattern recognition receptors, clearance by tissue macrophages and the institution of an inflammatory response. This...
Source: New Horizons in Translational Medicine - Category: Research Source Type: research
We aimed to study factors influencing outcomes of adults hospitalised for seasonal and pandemic influenza.  Individual-patient data from three Asian cohorts (Hong Kong, Singapore and Beijing; N=2649) were analysed. Adults hospitalised for laboratory-confirmed influenza (prospectively diagnosed) during 2008–2011 were studied. The primary outcome measure was 30-day survival. Multivariate Cox regression models (time-fixed and time-dependent) were used. Patients had high morbidity (respiratory/nonrespiratory complications in 68.4%, respiratory failure in 48.6%, pneumonia in 40.8% and bacterial superinfections in 10....
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Respiratory infections and tuberculosis Original Articles: Respiratory infections Source Type: research
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