Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis : case series

In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular. We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity. In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis. In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis

How to enhance experience and skill of non invasive ventilation: suggestions from the literature

The literature relevant to non invasive ventilation (NIV) synthesizes the most recent trends in enhancing experience and skill of NIV team care. Studies concerning ventilation team-based practices but also single respiratory health professional education and training were included in our research. Critical care education and training and inter-professional education should start in medical and post graduated school. Curriculum design, implementation, and assessment of clinical skills completed by the trained medical expert are essential components of competency-based education. Nurses, respiratory therapists and physiotherapists have different roles in ventilation team care around the world. Delivering effective training for NIV is challenging. Team-based care using patient simulation education as an adjunct to traditional clinical training (patient care, didactics, small group teaching and protocols) is superior to traditional clinical training alone and can affect positively patient and provider outcomes

Polymicrobial community-acquired pneumonia requiring mechanical ventilation: A case series

Polymicrobial pneumonia may cause by combinations of respiratory viruses and bacteria in a host. Colonization by Streptococcus pneumoniae was associated with increased risk of Intensive Care Unit admission or death in the setting of influenza infection whereas the colonization by methicillin resistant Staphylococcus aureus coinfection was associated with severe disease and death in adults and children. The principal association of pathogens in community-acquired pneumonia (CAP) is bacteria and viral coinfection and accounts approximately on 39% of microbiological diagnosed cases of CAP. The emergency of influenza virus H1N1 in 2009 caused the first pandemic in more than 40 years. Several studies found bacterial coinfection in a quarter and one-half of influenza infections, the pathogens more frequent isolates were S. pneumoniae and S. aureus mixed pneumonia in all patient groups. The high rate of viral bacterial infection in CAP, should suggest the consideration of new treatments, also during influenza season, the rapid detection of influenza virus (A or B) may allow physician the effective use of neuraminidase inhibitors within 36-48 h of symptoms onset, reducing the complication of secondary bacterial infection. On the other hand, prevention of mixed infection by influenza and pneumococcal vaccine should be addressed. The differential clinical diagnosis between a viral and a bacterial CAP is not easy: No clinical signs or radiological findings help the clinician to suspicious the diagnosis. In this case series, we report five different cases of severe polymicrobial CAP: All of them required mechanical ventilation: Invasive the first two and noninvasive ventilation the last three cases

Non-invasive ventilation in the treatment of severe polymicrobial community-acquired pneumonia

Polymicrobial pneumonia may be caused by the combination of respiratory viruses, bacteria and fungi in a host. Colonization by Streptococcus pneumoniae was associated with increased risk of Intensive Care Unit admission or death in the setting of influenza infection, whereas the colonization by methicillin sensible Staphylococcus aureus co-infection was associated with severe disease and death in adults and children. The principal association of pathogens in community-acquired pneumonia (CAP) is bacteria and viral co-infection, and accounts approximately for 39% of microbiological diagnosed cases of CAP. The differential clinical diagnosis between a viral and a bacterial CAP is not easy: no clinical signs or radiological findings help the clinician to suspect to the diagnosis. Patients with polymicrobial infections are more likely to have underlying medical conditions and have more severe outcome. Severe respiratory failure and need of mechanical ventilation occur in several cases. Non invasive ventilation (NIV) use aims to avoid invasive mechanical ventilation. NIV treatment is controversial owing to high reported treatment failure. In this case series we report three cases of severe polymicrobial CAP: all of them required NIV with a good outcome

Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis : case series

In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular. We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity. In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis. In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis

Is there an optimal level of positive expiratory pressure (PEP) to improve walking tolerance in patients with severe COPD?

Background: The application of positive expiratory pressure (PEP) devices during exercise had been proposed in order to counteract the pulmonary hyperinflation, reduce the dyspnea and thus increase the exercise tolerance in patients with severe chronic obstructive pulmonary disease (COPD). This randomized controlled crossover trial investigated the effect of two different levels of PEP (1 cmH(2)O and 10 cmH(2)O) on distance covered at 6 minute walk test (6 MWT) in patients with severe COPD. Secondary outcomes were the evaluation of PEP effects on physiological and pulmonary function variables.Methods: Seventy-two severe COPD patients, referred to our hospitals as in and out patients, were recruited. A basal 6 MWT without devices was performed on the first day, and then repeated with PEP 1 cmH(2)O (PEP1) and 10 cmH(2)O (PEP10), with a randomized crossover design. Slow and forced spirometries, including the inspiratory capacity measure, were repeated before and after each 6 MWT.Results: 50 patients (average age 69,92 year, mean FEV1 41,42% of predicted) concluded the trial. The 6 MWT improved significantly among both PEP levels and baseline (323,8 mt at baseline vs. 337,8 PEP1 and 341,8 PEP10; p < .002 and p < .018, respectively). The difference between PEP10 and PEP1 did not reach the significance. No improvements were found in pulmonary function, symptoms and physiological variables after the 6 MWT.Conclusions: In patients with severe COPD, the application of 1 cmH(2)O of PEP seems to improve the exercise tolerance as 10 cmH(2)O, with similar dyspnea. Further studies should investigate the effects of low levels of PEP on aerobic training programs

Diagnosis of lung cancer following emergency admission: Examining care pathways, clinical outcomes, and advanced NSCLC treatment in an Italian cancer Center

Background: Lung cancer patients diagnosed following emergency admission often present with advanced disease and poor performance status, leading to suboptimal treatment options and outcomes. This study aimed to investigate the clinical and molecular characteristics, treatment initiation, and survival outcomes of these patients. Methods: We retrospectively analyzed data from 124 patients diagnosed with lung cancer following emergency admission at a single institution. Clinical characteristics, results of molecular analyses for therapeutic purpose, systemic treatment initiation, and survival outcomes were assessed. Correlations between patients' characteristics and treatment initiation were analyzed. Results: Median age at admission was 73 years, and 79.0 % had at least one comorbidity. Most patients (87.1 %) were admitted due to cancer-related symptoms. Molecular analyses were performed in 89.5 % of advanced non-small cell lung cancer (NSCLC) cases. In this subgroup, two-thirds (66.2 %) received first-line therapy. Median overall survival (OS) was 3.9 months for the entire cohort, and 2.9 months for patients with metastatic lung cancer. Among patients with advanced NSCLC, OS was significantly longer for those with actionable oncogenic drivers and those who received first-line therapy. Improvement of performance status during hospitalization resulted in increased probability of receiving first-line systemic therapy. Discussion: Patients diagnosed with lung cancer following emergency admission demonstrated poor survival outcomes. Treatment initiation, particularly for patients with actionable oncogenic drivers, was associated with longer OS. These findings highlight the need for proactive medical approaches, including improving access to molecular diagnostics and targeted treatments, to optimize outcomes in this patient population