Use of Ultrasound for Diagnosis of Pneumonia in Adults, a Review

Pneumonia is a common lung infection with significant morbidity and mortality. Currently, the diagnosis of pneumonia is made by patient history confirmed with chest radiograph or computed tomography. These modalities, however, have limitations including low accuracy, radiation exposure, and high cost. Lung ultrasound has become more prevalent in evaluating pulmonary conditions and has shown to be highly accurate in the diagnosis of pneumonia. The purpose of this review is to discuss sonographic findings associated with pneumonia, techniques used to obtain quality images, and the evidence in literature supporting the use of lung ultrasound in the diagnosis of pneumonia. Numerous studies including meta-analysis have shown lung ultrasound to be highly accurate compared to chest radiographs. With proper techniques, lung ultrasound may be a promising alternative to chest radiographs and chest tomography in the diagnosis of pneumonia

Dirofilariose pulmonar humana: uma revisão da literatura e estudo de 7 casos.

Trabalho de Conclusão de Curso - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Departamento de Clínica Médica, Curso de Medicina, Florianópolis, 200

Human pulmonary dirofilariasis: a report of seven cases

Human pulmonary dirofilariasis is a rare disease caused by the parasite Dirofilaria immitis. It is usually seen as a solitary pulmonary nodule that mimics lung cancer. Although this disease is considered benign, its diagnosis often requires an excisional lung biopsy. Herein we report the epidemiological, clinical and radiological features observed in seven cases of human pulmonary dirofilariasis from Florianópolis. Six of our seven patients, showed a radiological finding of pulmonary nodule and underwent excisional lung biopsy for diagnosis. In one case, the radiological image was unavailable for review. Therefore, it was not described in this work, and the diagnosis was established through transbronchial biopsy.Dirofilariose pulmonar humana é uma doença rara causada pelo parasita Dirofilaria immitis. Apresenta-se usualmente como um nódulo pulmonar solitário que mimetiza câncer de pulmão. Embora considerada uma doença clinicamente benigna, uma biópsia pulmonar excisional é quase sempre necessária para o diagnóstico. Relatam-se as características epidemiológicas, clínicas e radiológicas de sete casos de dirofilariose pulmonar humana em Florianópolis. De sete pacientes relatados, seis tiveram como achado radiológico um nódulo pulmonar e foram submetidos à biópsia pulmonar excisional para o diagnóstico. Em um paciente, a imagem radiológica não estava disponível para revisão e, portanto, não foi descrita no trabalho; o diagnóstico foi estabelecido pela biópsia transbrônquica.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Prion Disease: A Challenging Diagnosis

Introduction: Human prion diseases are a group of rare encephalopathies resulting in rapidly progressive dementia and ultimately death. While there are no effective treatments for any form of prion disease, prompt and efficient diagnosis is essential to prevent the spread of the self-propagating protein, which may occur through aerosols, and avoid unnecessary or invasive testing. Diagnosis relies largely on physical examination, with many nonspecific findings, and laboratory testing, which has wide ranges of reported accuracy and high false positive rates with diseases such as Alzheimer’s dementia. Methods: Patients who underwent testing for prion disease were retrospectively identified from the electronic health records at a single-center university hospital. Presenting symptoms, as well as laboratory, radiographic, and electroencephalogram findings, were recorded and analyzed by group of final diagnosis, including prion disease, not prion disease, and undiagnosed. Results: There were 27 patients identified, two who had a final diagnosis of prion disease, 20 who had a formal diagnosis other than prion disease, and five who remained undiagnosed until death. There was a high degree of overlap in presenting symptoms. A high rate of false positive laboratory values, higher than previously reported, occurred for both the protein 14-3-3 and total Tau in cerebrospinal fluid. Magnetic resonance imaging ruled out prion disease most often. Testing with Rt-QuIC was the most diagnostic laboratory test. Both patients with a diagnosis of prion disease developed pneumonia and died of respiratory failure, and a total of nine patients required intubation for respiratory infections. Conclusion: Diagnosing prion disease remains a challenge due to nonspecific physical exam findings and symptoms and the high false positive rates of the laboratory algorithm. Testing with Rt-QuIC should be performed in patients that are critically ill or may have diseases known to cause high false positive rates of 14-3-3 or total Tau. Proper personal protective equipment should be used for any aerosol-generating procedure in patients who may have prion disease

Severity of disease and mortality for hospitalized patients with community-acquired viral pneumonia compared to patients with community-acquired bacterial pneumonia

Background: There exists a large body of literature to help identify, diagnose, treat, and manage community-acquired pneumonia (CAP). Despite this, there is little data that directly compares the clinical syndromes and complications of pure bacterial pneumonia to pure viral pneumonia. Our study compares the clinical presentation, morbidity and mortality of viral vs. bacterial etiologies of CAP. Methods: This was a secondary data analysis of the Community-Acquired Pneumonia Organization (CAPO) international study database. Data was collected concerning patient demographics, physical examination findings, laboratory findings, radiological findings, severity of illness, and clinical outcomes and stratified according to the two study groups, CAVP and CABP. A microbiological diagnosis of CABP was based on the isolation of a bacterium from a respiratory sample, blood culture and/or identification of a urinary antigen for Streptococcus or Legionella; microbiological diagnosis of CAVP was based on polymerase chain reaction or antigen detection from respiratory samples. Results: Our study included 1,913 patients. Of these, 286 (15.0%) had viral infection, while 1,627 (85.0%) had CAVP. We found that bacterial CAP patients are older, more frequently male, and suffer from a higher proportion of comorbidities when compared to viral CAP patients. Comparison of physical exam findings and laboratory values failed to find a clinically significant difference between bacterial and viral CAP patients. When comparing severity of illness, bacterial CAP patients had greater frequency of PSI ≥ class IV; however, viral CAP patients more frequently needed ICU admission, ventilator support, vasopressor support, and had higher rate of in hospital mortality. Conclusions: Our study confirms the extreme difficulty differentiating CABP from CAVP using demographics, physical exam, or x-ray findings. We found no major clinical or laboratory findings distinguishing CABP from CAVP. The increased severity of illness of CAVP compared to bacterial etiologies shows that PSI scores may not be an accurate indicator of severity of disease. More studies are needed to identify the best process of care for patients with CAP, including the potential benefits of routine respiratory viral panel testing and empiric antiviral therapy