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Antibiotic Strategies for Severe Community-Acquired Pneumonia
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1778641Despite advancements in health systems and intensive care unit (ICU) care, along with the introduction of novel antibiotics and microbiologic techniques, mortality rates in severe community-acquired pneumonia (sCAP) patients have not shown significant improvement. Delayed admission to the ICU is a major risk factor for higher mortality. Apart from choosing the appropriate site of care, prompt and appropriate antibiotic therapy significantly affects the prognosis of sCAP. Treatment regimens involving ceftaroline or ceftobiprole are currently considered the best options f...
Source: Seminars in Respiratory and Critical Care Medicine - February 1, 2024 Category: Respiratory Medicine Authors: Bassetti, Matteo Giacobbe, Daniele R. Magnasco, Laura Fantin, Alberto Vena, Antonio Castaldo, Nadia Tags: Review Article Source Type: research

Pulmonary Aspergillosis in People with Cystic Fibrosis
Semin Respir Crit Care Med 2024; 45: 128-140 DOI: 10.1055/s-0043-1777267In the last decade, fungal respiratory diseases have been increasingly investigated for their impact on the clinical course of people with cystic fibrosis (CF), with a particular focus on infections caused by Aspergillus spp. The most common organisms from this genus detected from respiratory cultures are Aspergillus fumigatus and Aspergillus terreus, followed by Aspergillus flavus, Aspergillus niger, and Aspergillus nidulans. These species have been identified to be both chronic colonizers and sources of active infection and may negatively impact lung...
Source: Seminars in Respiratory and Critical Care Medicine - January 29, 2024 Category: Respiratory Medicine Authors: Schwarz, C. Eschenhagen, P.N. Mainz, J.G. Schmidergall, T. Schuette, H. Romanowska, E. Tags: Review Article Source Type: research

Radiological Diagnosis of Pulmonary Aspergillosis
Semin Respir Crit Care Med 2024; 45: 050-060 DOI: 10.1055/s-0043-1776998Imaging plays an important role in the various forms of Aspergillus-related pulmonary disease. Depending on the immune status of the patient, three forms are described with distinct imaging characteristics: invasive aspergillosis affecting severely immunocompromised patients, chronic pulmonary aspergillosis affecting less severely immunocompromised patients but suffering from a pre-existing structural lung disease, and allergic bronchopulmonary aspergillosis related to respiratory exposure to Aspergillus species in patients with asthma and cystic fibro...
Source: Seminars in Respiratory and Critical Care Medicine - January 29, 2024 Category: Respiratory Medicine Authors: Laurent, Fran çois Benlala, Ilyes Dournes, Gael Tags: Review Article Source Type: research

Aspergillus and the Lung
Semin Respir Crit Care Med 2024; 45: 003-020 DOI: 10.1055/s-0043-1777259The filamentous fungus Aspergillus causes a wide spectrum of diseases in the human lung, with Aspergillus fumigatus being the most pathogenic and allergenic subspecies. The broad range of clinical syndromes that can develop from the presence of Aspergillus in the respiratory tract is determined by the interaction between host and pathogen. In this review, an oversight of the different clinical entities of pulmonary aspergillosis is given, categorized by their main pathophysiological mechanisms. The underlying immune processes are discussed, and the mai...
Source: Seminars in Respiratory and Critical Care Medicine - January 29, 2024 Category: Respiratory Medicine Authors: Janssens, Iris Lambrecht, Bart N. Van Braeckel, Eva Tags: Review Article Source Type: research

The Spectrum of Pulmonary Aspergillosis
Semin Respir Crit Care Med 2024; 45: 001-002 DOI: 10.1055/s-0043-1778126 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Respiratory and Critical Care Medicine)
Source: Seminars in Respiratory and Critical Care Medicine - January 29, 2024 Category: Respiratory Medicine Authors: Van Braeckel, Eva Cornely, Oliver A. Tags: Preface Source Type: research

Pathological Diagnosis of Pulmonary Aspergillosis
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1776757Pulmonary aspergillosis constitutes an increasingly prevalent and potentially fatal complex of mycotic diseases, caused by different species of Aspergillus. The broad spectrum of pathological manifestations associated with pulmonary aspergillosis necessitates a differentiation of commensalism from saprophytic colonization, hypersensitivity reactions, and true invasive infections, which highlights the importance of histopathology as a gold standard in a diagnostic setting. For the past decades, changes in terminology and contradicting contributions from different diagnos...
Source: Seminars in Respiratory and Critical Care Medicine - January 24, 2024 Category: Respiratory Medicine Authors: Jensen, Henrik E. Becker, Cecilie B. Tags: Review Article Source Type: research

Severe Community-Acquired Pneumonia in Immunocompromised Patients
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1778137Due to higher survival rates with good quality of life, related to new treatments in the fields of oncology, hematology, and transplantation, the number of immunocompromised patients is increasing. But these patients are at high risk of intensive care unit admission because of numerous complications. Acute respiratory failure due to severe community-acquired pneumonia is one of the leading causes of admission. In this setting, the need for invasive mechanical ventilation is up to 60%, associated with a high hospital mortality rate of around 40 to 50%. A wide range of pa...
Source: Seminars in Respiratory and Critical Care Medicine - January 24, 2024 Category: Respiratory Medicine Authors: Chean, Dara Windsor, Camille Lafarge, Antoine Dupont, Thibault Nakaa, Sabrine Whiting, Livia Joseph, Adrien Lemiale, Virginie Azoulay, Elie Tags: Review Article Source Type: research

Viral Pneumonia: From Influenza to COVID-19
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1777796Respiratory viruses are increasingly recognized as a cause of community-acquired pneumonia (CAP). The implementation of new diagnostic technologies has facilitated their identification, especially in vulnerable population such as immunocompromised and elderly patients and those with severe cases of pneumonia. In terms of severity and outcomes, viral pneumonia caused by influenza viruses appears similar to that caused by non-influenza viruses. Although several respiratory viruses may cause CAP, antiviral therapy is available only in cases of CAP caused by influenza virus...
Source: Seminars in Respiratory and Critical Care Medicine - January 16, 2024 Category: Respiratory Medicine Authors: Cilloniz, Catia Dy-Agra, Guinevere Pagcatipunan, Rodolfo S. Torres, Antoni Tags: Review Article Source Type: research

Microbiological Diagnosis of Pulmonary Aspergillus Infections
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1776777As microbiological tests play an important role in our diagnostic algorithms and clinical approach towards patients at-risk for pulmonary aspergillosis, a good knowledge of the diagnostic possibilities and especially their limitations is extremely important. In this review, we aim to reflect critically on the available microbiological diagnostic modalities for diagnosis of pulmonary aspergillosis and formulate some future prospects. Timely start of adequate antifungal treatment leads to a better patient outcome, but overuse of antifungals should be avoided. Current diag...
Source: Seminars in Respiratory and Critical Care Medicine - January 16, 2024 Category: Respiratory Medicine Authors: Aerts, Robina Feys, Simon Mercier, Toine Lagrou, Katrien Tags: Review Article Source Type: research

Treatment Failure and Clinical Stability in Severe Community-Acquired Pneumonia
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1778139Treatment failure and clinical stability are important outcomes in community-acquired pneumonia (CAP). It is essential to know the causes and risk factors for treatment failure and delay in reaching clinical stability in CAP. The study of both as well as the associated underlying mechanisms and host response are key to improving outcomes in pneumonia. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Seminars in Respiratory and Critical Care Medicine)
Source: Seminars in Respiratory and Critical Care Medicine - January 15, 2024 Category: Respiratory Medicine Authors: M éndez, Raúl Gonz ález-Jiménez, Paula Mengot, No é Men éndez, Rosario Tags: Review Article Source Type: research

Aspiration Pneumonia
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1777772Aspiration pneumonia is a lower respiratory tract infection that results from inhalation of foreign material, often gastric and oropharyngeal contents. It is important to distinguish this from a similar entity, aspiration with chemical pneumonitis, as treatment approaches may differ. An evolving understanding of the human microbiome has shed light on the pathogenesis of aspiration pneumonia, suggesting that dysbiosis, repetitive injury, and inflammatory responses play a role in its development. Risk factors for aspiration events involve a complex interplay of anatomical...
Source: Seminars in Respiratory and Critical Care Medicine - January 11, 2024 Category: Respiratory Medicine Authors: Pan, Di Chung, Samuel Nielsen, Erik Niederman, Michael S. Tags: Review Article Source Type: research

Acute Invasive Pulmonary Aspergillosis: Clinical Presentation and Treatment
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1777769Among all clinical manifestations of pulmonary aspergillosis, invasive pulmonary aspergillosis (IPA) is the most acute presentation. IPA is caused by Aspergillus hyphae invading the pulmonary tissue, causing either tracheobronchitis and/or bronchopneumonia. The degree of fungal invasion into the respiratory tissue can be seen as a spectrum, going from colonization to deep tissue penetration with angio-invasion, and largely depends on the host's immune status. Patients with prolonged, severe neutropenia and patients with graft-versus-host disease are at particularly high...
Source: Seminars in Respiratory and Critical Care Medicine - January 11, 2024 Category: Respiratory Medicine Authors: Heylen, Jannes Vanbiervliet, Yuri Maertens, Johan Rijnders, Bart Wauters, Joost Tags: Review Article Source Type: research

Antifungal Resistance in Pulmonary Aspergillosis
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1776997Aspergilli may cause various pulmonary diseases in humans, including allergic bronchopulmonary aspergillosis (ABPA), chronic pulmonary aspergillosis (CPA), and acute invasive pulmonary aspergillosis (IPA). In addition, chronic colonization may occur in cystic fibrosis (CF). Aspergillus fumigatus represents the main pathogen, which may employ different morphotypes, for example, conidia, hyphal growth, and asexual sporulation, in the various Aspergillus diseases. These morphotypes determine the ease by which A. fumigatus can adapt to stress by antifungal drug exposure, us...
Source: Seminars in Respiratory and Critical Care Medicine - January 9, 2024 Category: Respiratory Medicine Authors: Verweij, Paul E. Song, Yinggai Buil, Jochem B. Zhang, Jianhua Melchers, Willem J.G. Tags: Review Article Source Type: research

Biomarkers: Are They Useful in Severe Community-Acquired Pneumonia?
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1777771Community acquired pneumonia (CAP) is a prevalent infectious disease often requiring hospitalization, although its diagnosis remains challenging as there is no gold standard test. In severe CAP, clinical and radiologic criteria have poor sensitivity and specificity, and microbiologic documentation is usually delayed and obtained in less than half of sCAP patients. Biomarkers could be an alternative for diagnosis, treatment monitoring and establish resolution. Beyond the existing evidence about biomarkers as an adjunct diagnostic tool, most evidence comes from studies in...
Source: Seminars in Respiratory and Critical Care Medicine - January 9, 2024 Category: Respiratory Medicine Authors: P óvoa, Pedro Pitrowsky, Melissa Guerreiro, Gon çalo Pacheco, Mariana B. Salluh, Jorge I.F. Tags: Review Article Source Type: research

Microbiology of Severe Community-Acquired Pneumonia and the Role of Rapid Molecular Techniques
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1777770The microbiology of severe community acquired pneumonia (SCAP) has implications on management, clinical outcomes and public health policy. Therefore, knowledge of the etiologies of SCAP and methods to identify these microorganisms is key. Bacteria including Streptococcus pneumoniae, Staphylococcus aureus and Enterobacteriaceae continue to be important causes of SCAP. Viruses remain the most commonly identified etiology of SCAP. Atypical organisms are also important etiologies of SCAP and are critical to identify for public health. With the increased number of immunocomp...
Source: Seminars in Respiratory and Critical Care Medicine - January 9, 2024 Category: Respiratory Medicine Authors: Pickens, Chiagozie I. Gao, Catherine A. Morales-Nebreda, Luisa Wunderink, Richard G. Tags: Review Article Source Type: research