#Community Acquired Pneumonia

[flyonthewallmedstudent]

Psittacosis

Let's open with a case report, like we're on an episode of house.

Case Report

35 yo otherwise well, suddenly presents with 2/52 of high fevers and a headache (usually this means > 39)

a/w chills and rigours, responsive to medication/presumably panadol and intermittent (would resolve then come back)

no respiratory symptoms

She had neutrophilia and intrestingly, a CRP of merely 30.

CXR revealed nonspecific consolidation in 2 lobes, they followed this up with a CT revealing pretty impressive ground glass opacities (or GGOs)

She was empirically treated on IV tazocin only (I'm used to atypical coverage empirically started if there's even a whiff of resp, which she may not have had symptoms but her CXR confirms this)

eventually she was on referred to the authors, who felt her CT findings with consistent with psittacosis and treated her with doxycycline which resolved her symptoms in 48 hrs

on further history, it was revealed that she had parrots at home, one had died 2 days preceding her symptoms and she was sleeping next to its body at night (crazy)

What is it:

psittacosis is a zoonoses (transmitted by animals, animals = reservoirs), in this case, transmitted by birds. Orthinoses if birds in general, but psittacosis if referred to macaws, parrots etc. YOu can also catch it from chickens and turkeys.

Some what related is Bird fancier's lungs. Which just sounds fancy.. I'm sure it's just an old term.

Bird fancier's lung refers to a hypersensitivty pneumonitis (ILD) caused by bird exposure. DIfferent disease process, but birds is the come denominator. INhaled bird particles

Psittacosis specifically refers to the infective disease process caused by a bacteria. It was 'identified" or reported in the 1870s, when a cluster of 7 swiss patients developed the same symptoms and found to have possessed tropical birds.

Similarly, in the 1930s there was an outbreak in the US with a mortality of up to 20% (80% in pregnant women), also attributed to parrots from South America.

Eventually, with further scientific development, the causative pathogen was identified as chlamydia psittaci, an atypical intracellular organism.

Psittacosis is a significant differential to consider in community acquired pneumonia as it has a high mortality if left untreated. But it is rare, and causes about 1% of cases in the US. Part of this is due to improved hygiene practices and strict importation guidelines of tropical birds.

It's spread through the inhalation of dust with either dried faeces or respiratory secretions from infected birds.

Clinical features

Variable! but the key thing on history is birds

incubation time can be anywhere from 2 days to 20

Flu-like (fevers/chills/myalgias/arthralgias/malaise/headache)

high fevers is key

respiratory symptoms - does not always present as per the case report, and can be mild on spectrum (dry cough) to more severe

if systemic, can also get photophobia, deafness and epistaxis

Rare (particularly where doxycycline or azith are prescribed at a low threshold): hepatosplenomegaly (look out for LFTs), GI symptoms (remember CAP can present with diarrhoea, nausea/vomiting --> always do a CXR)

even rarer: endocarditis or myocarditis, encephalitis or hepatitis (usually the complications of untreated disease)

Increased risk groups:

pet shop owners

bird owners

farmers

zoo, lab workers where birds are kept, vets, avian quarantine station workers

poultry handlers/workers

So ask if they live or work with birds, or had recent exposure.

INvestigations

serology is gold standard - so looking for antibodies in blood tests

it's intracellular - so hard to culture if even possible on standard blood cultures

elevated ESR/CRP may see LFT derangement and creatinine rise in systemic illness

CXR- usually lower lobe changes, if CT is done, you can get pulmonary infiltrates with GGOs

Treatment:

usual culprits for atypical coverage: azithromycin 3 days or doxycycline 100 mg BD for 14/7

Differentials

always broad if systemic features only (also consider IE and other causes of sepsis)

with resp symptoms - legionella, Q fever, mycoplasma, tularaemia (except for tularaemia, the rest are also covered by doxycycline)

In clinical practice, I'm so used to just having atypicals on board for any cases of atypical pneumonia. I really take it for granted. But will consider this differential more myself in cases of PUO - but I feel like there should be at least CXR findings regardless.

Anyway, prognosis is very good so long as it is treated.

Sources:

CDC guidelines

Case Report: Importance of Clinical history in Psittacosis

StatPearls

Wiki

[philphys-survivalguide]

CAP

According to the Philippine Clinical Practice Guidelines for CAP in ADULTS (2020):

Unstable Co Morbids include: -> Uncontrolled DM -> Active malignancies -> Neurologic disease in evolution -> CHF FC II-IV -> Unstable CAD -> Renal Failure on dialysis -> Uncompensated COPD -> Decompensated Liver disease

Legionella urine antigen test and Influenza test are conditional recommendation for CAP HR: -> Influenza test may be done during periods of high influenza activity (July - January) if CAP HR is preceded by inluenza-like illness symptoms such as body malaise, rhinorrhea, arthralgia, sorethroat plus risk factors such as >60y/o, pregnant, asthmatic.

DRUGS: PENICILLINS: amoxicillin MACROLIDES: clarithromycin, azithromycin BETALACTAMS: co-amoxiclav, cefuroxime TETRACYCLINES: doxycycline NON PSEUDOMONAL BETALACTAMS: ampisul, cefotaxime, ceftriaxone FLUOROQUINOLONES: levofloxacin, moxifloxacin

Atypical coverage for Aspiration Pneumonia is only recommended if with suspicion of lung abscess or empyema.

Antiviral treatment is recommended with antibiotic therapy in CAP HR with risk factors mentioned under influenza testing.

Treatment should be initiated within 4 hours regardless of risk.

Duration of treatment: -> CAP LR , CAP MR: 5 days if stable -> May extend duration if pneumonia is not resolving, complicated by sepsis, infected with less common pathogens or infected with drug-resistant pathogens.

CXR post-treatment is recommended after a minimum of 6-08 weeks to establish a baseline and exclude other conditions but it is not recommended for routine testing in stable improving patients.

Inadequate Response after 72 hours of Empiric treatment: -> Reassess for possible resistance -> Reassess for the presence of other pathogens such as M. tuberculosis, viruses, parasites, or fungi.

Philippine CPG for CAP (Adults) 2020 Downloadable Link: https://www.psmid.org/cpg-management-and-prevention-of-adult-community-acquired-pneumonia-2020/

[herbs-and-poultices]

If anyone is considering getting community-acquired pneumonia this northern hemisphere sickness season, please allow me to advise against it. Not a fun time.

(For characters, though? I am sooo taking notes 😆)

[elipheleh]

David Wojnarowicz - Photo

Continuing my series of learning about things referenced in the book, I'm looking at things Alex references when he talks about engaging with queer history. These are all tagged #a series of learning about things that are referenced in the book, if you want to block the tag.

This post will cover the AIDS pandemic, which means there will be discussion of an incredibly large number of deaths, as well as government neglect of AIDS patients due to homophobia. There will be talk of the grief from the queer community & the ways it was weaponised to protest in an attempt for fundamental change. This is not a light topic, please take appropriate care when reading. As this post is going to have a few different topics in, so I decided to actually start with a read more, rather than arbitrarily place it partway down, I'd do a list of what is covered in this post & then have it all behind the cut.

So, in order, this post covers: David Wojnarowicz; AIDS; ACT-UP. In the additional reading section is a section subtitled "NAMES AIDS Memorial Quilt". This is worth looking into if you aren't already aware.

David Wojnarowicz is the man in the photo shown above, and referenced by Alex in the book. He was an AIDS activist, artist, writer, and filmmaker - among other things. He drew on his personal experiences with AIDS for his art & his political activism. In 1988, Wojnarowicz wore the leather jacket pictured above, with a pink triangle underneath text reading "if i die of aids - forget burial - just drop my body on the steps of the f.d.a." This jacket, and his similar sentiment from his book Close to the Knives, inspired David Robinson who - in 1991 - dumped the ashes of his deceased partner on the grounds of the White House in protest. These protests came to be known as "Ashes Action". Wojnarowicz died in his Manhattan home on July 22, 1992, aged 37, from what his boyfriend, Tom Rauffenbart, confirmed was AIDS. His ashes were scattered on the White House lawn in 1996.

-----

The AIDS epidemic in the US dates back to around 1970, but it wasn't until 1981 that cases started to come to light. The CDC (Centers for Disease Control and Prevention) published a report about 5 gay men becoming infected with a type of pneumonia only seen in people with compromised immune systems. As these men were healthy, this was unexpected. A year after, the New York Times published an article about a new immune system disorder, affecting over 300 people and killing over 100. Officials coined it GRID, gay-related immune deficiency, as it appeared to only be affecting gay men. It became officially known as AIDS (Acquired Immune Deficiency Syndrome) by August 1982, but was referred to as "gay plague" and many other derogatory terms for many years. Ninety-five and a half per cent of those diagnosed with AIDS between 1981 and 1987 died.

At the time, Ronald Reagan was president. He has been widely criticised for his reaction to the epidemic, for good reason. He didn't mention the word "AIDS" in public until 1985, by which time there had been 5636 deaths due to AIDS in the US. His first speech about the disease was delivered to the College of Physicians in Philadelphia in 1987, by which point there were more than 36,000 Americans living with AIDS & more than 20,000 had died. In the documentary When AIDS Was Funny (linked at the bottom), audios from press conferences in the early 1980s show how little the Reagan administration cared. Not only do they refer to AIDS as "gay plague", but joke around about it. It shows just how much the epidemic was derided - the people in charge of the country were so flippant about something so devastating, reflecting the general opinion of AIDS. Reagan's public support came overwhelmingly from the 'religious right', with Rev. Jerry Falwell using his political action group (the Moral Majority) to encourage homophobia aimed at gay men, especially those diagnosed with AIDS. Pat Buchanan, the White House Communications Director from 1985 to 1987, described the crisis as nature “exacting an awful retribution against gay men” in 1983.

Larry Kramer, when recalling the attempts to get help from public officials said:

You learn very fast that you’re a faggot, and it doesn’t make any difference that you went to Yale and were assistant to presidents of a couple of film companies, and that you had money. [source]

-----

On the 13th August, 1998, the Bay Area Reporter paper published a headline "No obits". For the first time in 17 years, there was finally a week without any deaths due to AIDS in the area covered by the paper - they are clear that there were deaths elsewhere, and they may have belated obituaries the following week, but for now this was a positive change. They had previously had up to 30 obituaries at points. Derek Gordon was quoted in the article as saying:

"I remember my grandfather said he knew he was getting near death because he used to scan the obits," he told the B.A.R. "I used to think how tragic because I was doing the same thing at 30."

-----

Wojnarowicz's jacket features a pink triangle on it. This was being used as a signal, as the pink triangle had been reclaimed by gay activists - originally in early 1970s Germany - to be used as a memorial to past victims & to protest continuing discrimination following its use by the Nazi Party to identify queer men in concentration camps. ACT-UP (AIDS Coalition To Unleash Power) adopted this icon, and turned it the other way up (so the point was at the top) and continue to use it to this day.

ACT-UP was formed in 1987, in New York City, and is now an international political group. It is working to end the AIDS pandemic using direct action, medical research & treatment, and trying to influence legislation. They debuted in October 1987, at the second National March on Washington for Lesbian and Gay Rights, not only by participating in the march but also with civil disobedience the day after. In the following October, ACT-UP shut down the F.D.A. (Food & Drug Administration) for a day in a demonstration against their drug approval process. The image of Wojnarowicz was taken that day, by William Dobbs. Activists shut down the F.D.A. by blocking the doors & walkways that would allow staff to get into the building. Some lay on the floor with faux-headstones, reading “DEAD FROM LACK OF DRUGS” and “VICTIM OF F.D.A. RED TAPE”. They attached a banner to the front of the building with ACT-UP's slogan - SILENCE = DEATH, bracketed by two pink triangles.

ACT-UP utilised different tactics from other groups - not only did they carry out (entirely non-violent) civil disobedience actions, but they also had the knowledge to be able to argue their demands successfully. The demonstration at the F.D.A. and their precise demands led to the F.D.A. listening to them and including them in decision making - and a year later their demands had started to come to fruition, with easier access to experimental drugs for those living with AIDS.

One 'Action' ACT-UP coordinated, was coined 'Ashes Action', as mentioned above. In 1992, ACT-UP marched to the White House fence to scatter the ashes of loved ones who had died due to AIDS onto the lawn of the White House. Inspired by Wojnarowicz's memoir, ashes were poured over the fence, demonstrating to the government explicitly the physical result of the AIDS policies. 'They had drums play a funeral cadence. They chanted—Bringing our dead to your door / We won't take it anymore and Out of the quilt and into the streets / Join us, join us. Unlike other protests, the Ashes Actions were not only meant to shock an uninterested public into empathy—they were meant as releases of grief for the activists themselves. "There was lots of room to scream and yell," Butler said, "but it wasn't always conducive to the work of mourning. I knew none of the people whose ashes we were carrying, but I remember when the ashes went over the fence of the White House. I just don't remember convulsive grief like the grief I felt in that moment."' [source]

sixteen, ashes of your forerunners rest on the lawn of the White House because SIXTEEN, THEY HAVE ALWAYS WATCHED US DIE. -SpondeeSoliloquy - Seventeen things (alternate link)

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I had to cut down a lot of the information here, so I would really appreciate it if you took the time to have a look through the additional reading below, there was a lot of things I would have added if I had the space.

-----

Sources: Wikipedia - David Wojnarowicz Guardian - David Wojnarowicz: still fighting prejudice 24 years after his death NY Times AIDS Timeline 1980-1987 History.com - History of AIDS Wikipedia - History of HIV/AIDS vox.com - The Reagan administration's unbelievable response to the HIV/AIDS epidemic US Studies Online The AIDS Crisis and the US Presidency SFGate - Reagan's AIDS Legacy / Silence equals death Washington Post - Pat Buchanan's Greatest Hits Wikipedia - Moral Majority Bay Area Reporter - No Obits Wikipedia - Pink Triangle Wikipedia - ACT UP New Yorker - How ACT UP Changed America Vice - Why the Ashes of People With AIDS on the White House Lawn Matter Pioneer Works - The Jacket

Additional Reading: When AIDS Was Funny - Documentary Film (cw for images of very unwell aids patients) LA Times - Police Arrest AIDS Protesters Blocking Access to FDA Offices Youtube - ACT UP Ashes Action 1992 Washington Post - AIDS ACTIVISTS THROW ASHES AT WHITE HOUSE Wikipedia - How to Survive a Plague Wikipedia - The Normal Heart (originally a play), 2014 film BBC - The drama that raged against Reagan’s America Wikipedia - Silence=Death Project Brooklyn Museum - Silence = Death Wikipedia - And The Band Played On - Randy Shilts NPR - How To Demand A Medical Breakthrough: Lessons From The AIDS Fight ACT-UP oral histories ClassicFM - Sobering black-and-white image of a gay men’s choir reminds of loss of life during AIDS epidemic Snopes - Does a Poignant Photo of Gay Men's Choir Show Devastating Impact of HIV/AIDS? Why We Fight - Vito Russo NAMES AIDS Memorial Quilt Wikipedia - NAMES Project AIDS Memorial Quilt national aids memorial - quilt history Cleve Jones interview (specifically: How he came up with the idea for the AIDS Quilt) View the NAMES AIDS memorial quilt online

[covid-safer-hotties]

The Risks of Killing a COVID Early Warning System - Published August 1, 2024

In Ontario, the government is rolling back its detection program. Doctors are speaking out about what’s at stake.

COVID-19 is surging in parts of North America and Europe, and even played a role in ending the presidential campaign of 81-year-old Joe Biden, who was infected for the third time last month.

Nevertheless, on Wednesday the Ontario government shut down its early warning system to detect COVID and other emerging diseases.

Doctors, citizens and researchers are calling the decision to kill the province’s wastewater disease surveillance program both wrong-headed and dangerous. Ending the program will make it harder to track and thwart viral outbreaks, they say, and thereby increase the burden on Ontario’s understaffed hospitals, which experienced more than 1,000 emergency room closures last year.

“Pandemics do not end because science has been muzzled,” Dr. Iris Gorfinkel, a well-known Toronto physician and clinical researcher, told the CBC.

In emails to politicians, more than 5,000 citizens have demanded restoration of the program, with little effect.

The Tyee is supported by readers like you Join us and grow independent media in Canada In 2020, at the height of the pandemic, Ontario launched one of the world’s most comprehensive disease surveillance systems by sampling wastewater.

For five days a week since then, sewage water has been monitored for signs of COVID and its variants.

The viral particles can be detected in wastewater seven days before people experience symptoms, giving an invaluable head start on public health measures and allowing advance warning of surges in illness. The system was expanded to include wastewater testing for monkeypox, influenza and respiratory syncytial virus, or RSV, and even drug-resistant bacteria, at more than 56 locations in the province. The system covered all 34 public health districts.

Unlike other forms of testing, wastewater surveillance is relatively cheap and can be done in a small university lab. It also provides reliable updates that decision-makers and the public could easily follow in real time.

The monitoring helped millions at high risk from COVID infections, including the elderly and citizens with cancer and other immune suppressive disorders, to determine the incidence of the virus in their communities. It gave them information about when to make medical appointments, where to mask up and when to avoid crowded indoor events.

For many Indigenous communities with substandard and crowded housing, the program also served as an early warning system for waves of respiratory diseases.

The program also provided timely warnings to parents on the risk of infants acquiring RSV, which can cause pneumonia. Hospitals, too, regularly used the results to prepare for staffing and resource challenges in the wake of infectious viral waves including COVID and RSV.

Read more at either link!

[teachingrounds]

Q. How long should an outpatient be treated with antibiotics for bacterial community acquired pneumonia?

a. 3 days

b. 5 days

c. 7 days

d. 10 days

e. 14 days

A. Most patients require 5 days of therapy; 3 days is appropriate if they are stable and have been afebrile for at least 48 hours. It may be appropriate to prolong the course by 3-5 days if symptoms recur shortly after cessation.

Image of amoxicillin-clavulanate by Sage Ross, WikiCommons.

[mariacallous]

Chinese Hospitals Are Housing Another Deadly Outbreak

In Beijing and other megacities in China, hospitals are overflowing with children suffering pneumonia or similar severe ailments. However, the Chinese government claims that no new pathogen has been found and that the surge in chest infections is due simply to the usual winter coughs and colds, aggravated by the lifting of stringent COVID-19 restrictions in December 2022. The World Health Organization (WHO) has dutifully repeated this reassurance, as if it learned nothing from Beijing’s disastrous cover-up of the COVID-19 outbreak.

There is an element of truth in Beijing’s assertion, but it is only part of the story. The general acceptance that China is not covering up a novel pathogen this time appears reassuring. In fact, however, China could be incubating an even greater threat: the cultivation of antibiotic-resistant strains of a common, and potentially deadly, bacteria.

Fears of another novel respiratory pathogen emerging from China are understandable after the SARS and COVID-19 pandemics, both of which Beijing covered up. Concerns are amplified by Beijing’s ongoing obstruction of any independent investigation into the origins of SARS-CoV-2, the virus that causes COVID-19—whether it accidentally leaked from the Wuhan lab performing dangerous gain-of-function research or derived from the illegal trade in racoon dogs and other wildlife at the now-infamous Wuhan wet-market.

Four years ago, during the early weeks of the COVID-19 outbreak, Beijing failed to report the new virus and then denied airborne spread. At pains to maintain their fiction, Chinese authorities punished doctors who raised concerns and prohibited doctors from speaking even to Chinese colleagues, let alone international counterparts. Chinese medical statistics remain deeply unreliable; the country still claims that total COVID-19 deaths sit at just over 120,000, whereas independent estimates suggest the number may have been over 2 million in just the initial outbreak alone. Now, Chinese doctors are once again being silenced and not communicating with their counterparts abroad, which suggests another potentially dangerous cover-up may be underway.

We don’t know exactly what is happening, but we can offer some informed guesses.

The microbe causing the surge in hospitalization of children is Mycoplasma pneumoniae, which causes M. pneumoniae pneumonia, or MPP. First discovered in 1938, the microbe was believed for decades to be a virus because of its lack of a cell membrane and tiny size, although in fact it is an atypical bacterium. These unusual characteristics makes it invulnerable to most antibiotics (which typically work by destroying the cell membrane). The few attempts to make a vaccine in the 1970s failed, and low mortality has provided little incentive for renewed efforts. Although MPP surges are seen every few years around the world, the combination of low mortality and difficult diagnostics has meant there is no routine surveillance.

Although MPP is the most common cause of community-acquired pneumonia in school children and teenagers, pediatricians such as myself refer to it as “walking pneumonia” because symptoms are relatively mild. Respiratory Syncytial Virus (RSV), influenza, adenoviruses, and rhinoviruses (also known as the common cold) all cause severe inflammation of the lungs and are far more common causes of emergency-room visits, hospitalization, and death in infants and young children. Why should MPP be acting differently now?

One contributing factor to the severity of this outbreak may be “immunity debt.” Around the globe, COVID-19 lockdowns and other non-pharmaceutical measures meant that children were less exposed to the usual range of pathogens, including MPP, for several years. Many countries have since seen rebound surges in RSV. Several experts agree with Beijing’s explanation that the combination of winter’s arrival, the end of COVID-19 restrictions, and a lack of prior immunity in children are likely behind the surging infections. Some even speculate that that substantial lockdown may have particularly compromised young children’s immunity, because exposure to germs in infancy is essential for immune systems to develop.

In China, MPP infections began in early summer and accelerated. By mid-October, the National Health Commission had taken the unusual step of adding MPP to its surveillance system. That was just after Golden Week, the biggest tourism week in China.

Infection by two diseases at the same time can make things worse. The usual candidates for coinfection in children—RSV and flu—have not previously caused comparable surges in pneumonia. One difference this time is COVID-19. It is possible that the combination of COVID-19 and MPP is particularly dangerous. Although adults are less susceptible to MPP due to years of exposure, adults hospitalized for COVID-19 who were simultaneously or recently coinfected by MPP had a significantly higher mortality rate, according to a 2020 study.

Infants and toddlers are immunologically naive to MPP, and unlike COVID-19, RSV, and influenza, there is no vaccine against MPP. It seems implausible that no child (or adult) has died from MPP, yet China has not released any data on mortality, or on extrapulmonary complications such as meningitis.

Most disturbing, and a fact being downplayed by Beijing, is that M. pneumoniae in China has mutated to a strain resistant to macrolides, the only class of antibiotics that are safe for children less than eight years of age. Beyond discouraging parents to start ad hoc treatment with azithromycin, the most common macrolide and the usual first-line antibiotic for MPP, Beijing has barely mentioned this fact. Even more worrying is that WHO has assessed the risk of the current outbreak as low on the basis that MPP is readily treated with antibiotics. Broader azithromycin resistance in MPP is common across the world, and China’s resistant strain rates in particular are exceptionally high. Beijing’s Centers for Disease Control and Prevention reported macrolide resistance rates for MPP in the Beijing population between 90 and 98.4 percent from 2009 to 2012. This means there is no treatment for MPP in children under age eight.

Fears over a novel pathogen are already abating. After all, MPP is rarely lethal. But antimicrobial resistance (AMR) is. Responsible for 1.3 million deaths a year, AMR kills more people than COVID-19. No country is immune to this growing threat. Since China, where antibiotics are regularly available over the counter, leads the world in AMR, it is inconceivable that this issue hasn’t yet come up, particularly during WHO’s World AMR Awareness week, from Nov. 18 to Nov. 24.

Any infectious disease physician would want to know: Did WHO asked China the obvious question—what is the level of azithromycin resistance of M. pneumonia in the current outbreak—and include the answer in its risk assessment? Or did it ask about resistance to doxycycline and quinolones, antibiotics that can be used to treat MPP in adults? Even if WHO did ask, China isn’t telling, and WHO isn’t talking.

China’s silence isn’t surprising. Its antibiotic consumption per person is ten times that of the United States, and policies for AMR stewardship are predominantly cosmetic. While surveillance is China’s strong point, reporting is not.

Despite Spring Festival, the Chinese celebration of the Lunar New Year and another peak travel period, approaching in February 2024, WHO hasn’t advised any travel restrictions. It should have learned the danger of accepting Beijing’s statements at face value. Four years ago, Beijing’s delay enabled more than 200 million people to travel from and through Wuhan for Spring Festival. That helped COVID-19 go global. Since China’s AMR rates are already so high, importing AMR from other countries isn’t a major concern for China. Export is the issue, and China’s track record in protecting other countries is abysmal.

Rather than repeating the self-serving whitewashing coming from Beijing, WHO should be publicly pressing China about the threat of mutant microbes. Halting AMR is essential. Before antisepsis and antibiotics, surgery was a treatment of last resort. Without antibiotics, we lose 150 years of clinical and surgical advances. Within ten years, we are at risk of few antibiotics being effective. It may not be the novel virus that people were expecting, but the next pandemic is already here.

[gumjrop]

Pediatric pneumonia cases requiring hospitalization are up 30% in Central Virginia.

While not a cause for panic, it does call for caution.

Christopher Doern, M.D., director of microbiology at VCU Health, said the initial investigations suggest that this rise in hospitalizations may be because of an increase in rhinovirus and enterovirus.

“The last time we saw this phenomenon was in 2014 during the EVD68 outbreak,” Doern said. “I don't have any speculation as to why this is only being observed in Central Virginia and would be surprised if it doesn't soon disseminate to the rest of the region and beyond.”

David Marcello, M.D., chief of pediatric hospital medicine, answers some key questions about the spike in pneumonia cases and the type of care being provided at Children’s Hospital of Richmond at VCU.

What might be causing this current rise in pediatric pneumonia?

In addition to increased Mycoplasma infections (atypical bacterial pneumonia), community acquired bacterial infections, we’re also seeing a spike in rhinovirus/enterovirus infections. These are two types of the many respiratory viral infections that typically rise this time of year with back to school, weather changes and increased pollen counts. It may be that there’s a new strain of rhinovirus or enterovirus that is more virulent than in the past, something that occurs every 6-10 years. We know viral infections can also lead to bacterial pneumonias (typical or atypical).

What care is your team providing for children in the hospital with pneumonia?

These children are provided supportive care in the hospital, which varies depending on their specific symptoms and needs. It may include hydration via IV or by mouth, or oral hydration via nasogastric tube (tube from nose to stomach) for children who can’t take liquids by mouth. Oral is always preferred, especially now with the shortage of IV fluids due to Hurricane Helene storm damage. They may also receive oxygen through a nasal cannula, mask or in very severe cases a ventilator (with a tube from the mouth into the breathing passages).

Antibiotics are an important component of care if a bacterial infection is suspected. We’ll also give steroids and albuterol to patients who experience an asthma attack in addition to their pneumonia.

Do you expect that this will improve or get worse in the coming weeks?

It’s likely to worsen with pollen and mold counts rising, colder weather keeping everyone inside and the holidays bringing people together. Asthma is triggered by infection and cold weather, so we often see patients with asthma needing extra care this time of year as well.

When should families seek medical care for children’s respiratory symptoms?

Not all cases of respiratory illness require care in a medical setting. That said, if you notice any of the following symptoms, we urge you to check with the pediatrician if possible or bring your child to the emergency room:

High fever (higher than 100.4˚F for infants younger than 3 months, or higher than 102.2˚F in children older than 3 months) that lasts more than 2-3 days despite Tylenol and/or Motrin

Inability to drink liquids or vomiting so much that they’re not urinating regularly (fewer than three wet diapers per day in an infant, using the bathroom less than once per day in older children)

Dry lips or mouth

Working hard to breathe/catch their breath (seeing their ribs with each breath, belly breathing more than usual, gasping for air, inability to speak if they’re typically verbal)

If your child has asthma, cough with wheezing, needing more than four breathing treatments per day, and working hard to breathe with no response to breathing treatments would all warrant medical assessment and care.

Should families try any care at home for respiratory symptoms before seeking medical treatment?

For mild symptoms, we encourage lots of liquids and Tylenol or Motrin for pain relief. Honey can help decrease cough but should only be given to children over 1 year of age (there’s a risk of botulism in little ones with immature digestive tracts). Children with asthma should follow their asthma action plan instructions.

If symptoms begin to cause concern, seek medical care right away.

What are the best ways to protect ourselves and our kids from getting sick?

Infection prevention measures are essential, including:

Washing your and your child's hands

Staying home and away from others until symptoms are improving and there is no fever for 24 hours without the assistance of fever-reducing medication

Getting the flu vaccine (now is the time to get the vaccine and start building immunity)

Staying up to date on COVID-19 vaccines

Getting all childhood vaccines on schedule

Wearing a mask if tolerated, especially if you have a weakened immune system or are recovering from illness

A version of this story was originally published by Children’s Hospital of Richmond at VCU

[tubetrading]

The Role of Ertapenem 100 mg in Modern Antibiotic Therapy

In recent years, the growing challenge of antibiotic resistance has prompted healthcare professionals to explore newer therapeutic options.  Among these, Ertapenem 100 mg has emerged as a significant player in modern antibiotic therapy.  This broad-spectrum antibiotic belongs to the carbapenem class and is renowned for its effectiveness against a variety of infections, particularly those caused by Gram-negative bacteria.  In this blog, we will delve into the importance of Ertapenem, its applications, and its availability through Ertapenem 100 mg injection manufacturers in India, exporters, suppliers, and distributors.

Understanding Ertapenem

Ertapenem is a synthetic beta-lactam antibiotic that offers potent activity against a wide range of bacterial pathogens.  Its unique structure allows it to penetrate bacterial cell walls effectively, making it suitable for treating complex infections, including those originating from intra-abdominal sources, skin and soft tissue infections, and pneumonia.  Given the rising rates of resistance to commonly used antibiotics, Ertapenem provides a vital alternative for clinicians seeking reliable treatment options.

The Need for Effective Antibiotics

The World Health Organization (WHO) has recognized antibiotic resistance as one of the most significant global health threats.  With an increasing number of bacterial strains becoming resistant to traditional therapies, the role of advanced antibiotics like Ertapenem has become crucial.  The ability of Ertapenem to maintain its efficacy against resistant strains makes it an essential component of modern treatment regimens.

Applications of Ertapenem 100 mg

Ertapenem is indicated for various infections, including:

Intra-abdominal Infections:  It is often used to treat complicated intra-abdominal infections due to its broad spectrum of activity.

Skin and Soft Tissue Infections:  Ertapenem is effective against multiple pathogens commonly responsible for skin infections.

Pneumonia:  This antibiotic is also a go-to treatment for community-acquired pneumonia.

Complicated Urinary Tract Infections:  Ertapenem can be a critical option when dealing with complicated cases.

The versatility of Ertapenem makes it a valuable asset in a clinician's toolkit, particularly for patients who have not responded to other antibiotic therapies.

Availability in India

Ertapenem 100 mg Injection Manufacturers in India

India has a robust pharmaceutical industry, recognized for producing high-quality medications at competitive prices.  Numerous Ertapenem 100 mg injection manufacturers in India are dedicated to maintaining stringent quality standards while ensuring that their products meet international guidelines.  These manufacturers play a vital role in making Ertapenem accessible to healthcare facilities across the country and abroad.

Ertapenem 100 mg Injection Exporters in India

The global demand for effective antibiotics has led to an increase in Ertapenem 100 mg injection exporters in India.  These exporters are crucial in supplying this essential medication to international markets, contributing to India's reputation as a leader in the global pharmaceutical landscape.  The adherence to quality and regulatory standards has helped these exporters establish strong relationships with healthcare providers worldwide.

Ertapenem 100 mg Injection Suppliers in India

A reliable supply chain is fundamental for the availability of Ertapenem in hospitals and clinics.  Numerous Ertapenem 100 mg injection suppliers in India ensure that healthcare institutions receive timely deliveries of this critical antibiotic.  These suppliers work closely with manufacturers to maintain a steady stock, facilitating uninterrupted access to essential medications.

Ertapenem 100 mg Injection Distributors in India

The role of Ertapenem 100 mg injection distributors in India is equally important.  They bridge the gap between manufacturers and healthcare providers, ensuring that the product reaches the end-users efficiently.  Distributors are vital in managing logistics, handling regulatory compliance, and addressing the needs of various healthcare institutions.  Their efforts ensure that doctors have immediate access to this antibiotic, particularly in emergency situations.

Best Indian Pharma Industry 2024

The best Indian pharma industry 2024 is characterized by innovation, quality, and a commitment to addressing public health challenges.  With a focus on research and development, Indian pharmaceutical companies are continually improving their product offerings.  The introduction of advanced antibiotics like Ertapenem is a testament to the industry’s efforts to combat antibiotic resistance.  The commitment to maintaining high manufacturing standards and complying with international regulations has solidified India’s position as a trusted source for pharmaceuticals worldwide.

Conclusion

The role of Ertapenem 100 mg in modern antibiotic therapy cannot be overstated.  As antibiotic resistance continues to pose significant challenges to healthcare, the importance of effective and reliable treatments like Ertapenem becomes even more critical.  The collaboration among Ertapenem 100 mg injection manufacturers, exporters, suppliers, and distributors in India has made this essential antibiotic readily available to healthcare providers, ensuring that patients receive the best possible care.

In 2024, as the best Indian pharma industry continues to evolve, the ongoing development and distribution of innovative antibiotics will remain pivotal in the fight against infectious diseases.  By prioritizing access to effective medications, we can work towards a healthier future and combat the ever-growing threat of antibiotic resistance.

[hamutxt]

bro is going community-acquired pneumonia mode

[mcatmemoranda]

CURB-65 can be used as a tool for determining disposition for patients diagnosed with community-acquired pneumonia. It is a scoring system based on a patient's confusion, BUN value, respirations, blood pressure, and age. Those with a score of 0 and sometimes 1 can generally be managed on an outpatient basis.

[drambikachestclinic]

What are the main types of pneumonia?

Pneumonia is a lung infection that can be caused by various organisms, including bacteria, viruses, fungi, and parasites. The main types of pneumonia are generally classified based on where and how the infection was acquired. Here are the primary types:

Community-Acquired Pneumonia (CAP):

This type of pneumonia is acquired outside of healthcare settings, such as hospitals or nursing homes.

It is often caused by bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and atypical bacteria like Mycoplasma pneumoniae.

Viruses, including influenza, respiratory syncytial virus (RSV), and coronaviruses, can also cause CAP.

Hospital-Acquired Pneumonia (HAP):

HAP occurs in patients during their stay in a hospital, typically 48 hours or more after admission.

It is often caused by more resistant bacteria such as Staphylococcus aureus (including MRSA) and Pseudomonas aeruginosa.

Patients with weakened immune systems or those who are on ventilators are at higher risk.

Ventilator-Associated Pneumonia (VAP):

A subtype of HAP, VAP occurs in people who are on mechanical ventilation for at least 48 hours.

The causative agents are often similar to those of HAP, with a higher likelihood of being multi-drug resistant organisms.

Healthcare-Associated Pneumonia (HCAP):

This type includes pneumonia in patients who are in regular contact with healthcare settings, such as nursing homes, dialysis centers, or outpatient clinics.

Like HAP, HCAP can be caused by antibiotic-resistant bacteria.

Aspiration Pneumonia:

Occurs when food, liquid, saliva, or vomit is inhaled into the lungs, leading to an infection.

It is more common in individuals with swallowing difficulties or those who are unconscious or have impaired gag reflexes.

Atypical Pneumonia:

Often referred to as "walking pneumonia," it is typically less severe and has a different clinical presentation.

Caused by atypical bacteria such as Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila.

Symptoms are usually milder compared to typical bacterial pneumonia.

Fungal Pneumonia:

Caused by fungi, more common in people with weakened immune systems.

Examples include Histoplasmosis, Coccidioidomycosis, and Cryptococcosis.

Viral Pneumonia:

Common in children and older adults, often caused by viruses such as influenza, respiratory syncytial virus (RSV), and coronaviruses (including SARS-CoV-2).

Each type of pneumonia has different risk factors, causative organisms, and treatments, making accurate diagnosis and appropriate management crucial.

[swasli]

Why Choose Camp X-Ray for Your Diagnostic Needs

Clear Perspective: How Camp X-Ray Enhances Diagnostic 

Accuracy

In the realm of medical diagnostics, the choice of imaging services plays a pivotal role in accurate diagnosis and treatment planning. Camp X-Ray services stand out as a cornerstone in this domain, offering advanced technology, skilled professionals, and a commitment to precision. This blog explores the reasons why Camp X-Ray should be your preferred choice for diagnostic needs, highlighting its benefits, technological advancements, and impact on patient care.

Medical diagnostics have undergone significant advancements over the years, revolutionizing how healthcare providers detect, diagnose, and treat various medical conditions. Among these advancements, Camp X-Ray services have emerged as a critical component in the diagnostic toolkit, providing healthcare professionals with essential insights through advanced imaging technology.

Precision and Accuracy

Camp X-Ray services are renowned for their precision and accuracy in diagnostic imaging. Unlike traditional methods, such as film-based X-rays, Camp X-Ray facilities employ digital radiography (DR) and computed radiography (CR) systems. These technologies offer several advantages:

High-Resolution Imaging: Digital X-ray systems produce detailed, high-resolution images that allow healthcare providers to visualize anatomical structures with exceptional clarity.

Enhanced Diagnostic Capabilities: The clarity of digital images enables healthcare professionals to detect subtle abnormalities, leading to earlier detection and more accurate diagnoses of medical conditions.

Reduced Radiation Exposure: Digital X-ray systems typically require lower radiation doses compared to conventional film-based X-rays, ensuring patient safety without compromising image quality.

Optimizing Medical Care: Efficiency and Improved Outcomes

Camp X-ray services offer significant advantages for medical  professionals and healthcare facilities:

Faster Diagnosis:  The speed and convenience of Camp X-ray's mobile X-ray services enable physicians to acquire X-ray results quickly.  This can expedite the diagnostic process and potentially lead to faster and more effective treatment plans for patients.

Improved Workflow:  For clinics and medical facilities, the availability of on-site  X-ray services can significantly improve their workflow.  Eliminating the need for referrals to external imaging centers and streamlining the diagnostic process allows clinics to serve patients more efficiently and effectively.

Enhanced Patient Care:  By prioritizing patient comfort and reducing wait times, Camp X-ray services contribute to a more positive overall healthcare experience for patients.  This can translate into improved patient satisfaction and higher adherence to treatment plans.

Camp X-Ray Services: More Than Just Convenience

While convenience is a significant advantage of Camp X-ray services, their offerings extend beyond simply bringing X-ray imaging to your doorstep. Here's a deeper dive into some of the additional benefits they provide:

Specialized Services:  Camp X-ray caters to a wide range of diagnostic needs. They offer specialized X-ray services for various body parts, including bones, chest (for pneumonia or other respiratory issues), and extremities (for fractures or sprains). Additionally, they can perform portable X-rays for patients in critical care situations.

Improved Communication:  Camp X-ray prioritizes clear communication with both patients and healthcare providers. Their technicians explain the X-ray procedure clearly to patients, addressing any questions or concerns.  Additionally, they ensure the timely delivery of high-quality digital X-ray images to physicians for rapid diagnosis.

Flexibility and Scalability:  Camp X-ray services are highly adaptable to meet diverse scheduling needs. They offer flexible scheduling options to accommodate patient availability and clinic workflows. Furthermore, their mobile units can be scaled to handle various patient volumes, ensuring efficient service for both large medical facilities and smaller clinics.

Reduced Costs:  While the exact cost structure of Camp X-ray services may vary depending on location and specific requirements, their services can potentially lead to cost savings for healthcare providers. Reduced transportation costs and streamlined workflows can contribute to overall cost optimization within healthcare facilities.

Safety and Quality: Maintaining High Standards

Camp X-ray services are built on a foundation of safety and quality:

Experienced Technicians:  Camp X-ray employs highly trained and certified technicians who adhere to strict protocols to ensure proper X-ray procedures and patient safety during on-site imaging.

Advanced Technology:  Their mobile X-ray units utilize state-of-the-art equipment that delivers high-quality digital X-ray images.  These digital images facilitate accurate diagnosis by physicians.

Safety Protocols:  Camp X-ray adheres to industry-standard radiation safety protocols.  They utilize techniques and equipment that minimize patient exposure to radiation during X-ray imaging.

Camp X-ray services are not just about convenience; they represent a paradigm shift in diagnostic imaging.  Their commitment to patient comfort,  efficiency, and safety is transforming the way X-rays are performed.  By bringing imaging directly to patients, Camp X-ray service are creating a more positive and streamlined diagnostic experience for everyone involved in the healthcare journey.  As the demand for convenient and efficient diagnostic solutions grows, Camp X-ray service are poised to play a pivotal role in shaping the future of medical care.

[teachingrounds]

Q. What are the short- and long-term mortality for patients hospitalized with community acquired pneumonia (CAP)?

A. Of patients hospitalized with CAP, 10-15% die within 30 days of diagnosis, 30-35% die within 1 year of hospitalization, and 50% die within 1 year of an ICU stay with severe CAP.

Source: File & Ramirez, "Community-Acquired Pneumonia," NEJM (2023), DOI: 10.1056/NEJMcp2303286.