Association of Lung cancer with Pneumonia and Chlamydia pneumoniae infection

Introduction: The degree of association and type of causal versus non-causal relationship between pneumonia and lung cancer (LC) are evolving discussions. We reviewed English publications on the degree of association between pneumonia and subsequent LC. Methods: We searched the PubMed database using key words for pneumonia, LC, and chlamydia infection. We selected peer-reviewed studies of patients with pneumonia and LC. Case reports and other literature reviews were excluded from this review. Results: Five studies examined the incidence and/or risk of LC for a total of 415,750 patients, and four studies examined cases with Chlamydia pneumoniae chronic infection at the time of diagnosis of LC for a total of 1,467 patients. The overall risk and/or incidence of LC after pneumonia was from 2.3% to 10% for a median follow-up ranging from 109 days to 4.2 years. Three studies reported current tobacco smoking status, which ranged from 27.7% to 45% among those with LC. A history of prior malignancy was reported in 22.5% of patients with LC. Chlamydia IgA and LC were statistically non-significantly associated regardless of the age of the patients. In one study, Chlamydia HP-60 IgG \u3e 1:50 was associated with significantly increased odds of LC in two respective models (ORs of 1.34 [95% CI 1.06–1.69] and 1.30 [95% CI 1.02–1.67]). A fourth study reported C. pneumoniae IgA \u3e 64 titers to be 58%, 29%, and 5.5% among patients with LC, without LC, and healthy blood donors, respectively. Conclusions: The incidence of LC was reported to range from 2.3% to 10.3% following an episode of pneumonia. There is limited evidence of the association of chronic Chlamydia infection with LC, and Chlamydia could be a causal cofactor of LC

Pulmonary Post-Acute Sequelae of COVID-19

Introduction: Persistent symptoms have been observed in a substantial proportion of survivors of COVID-19 since relatively early in the pandemic. Among these post-acute sequelae of COVID-19 (PASC), respiratory symptoms appear to be the most prevalent. Methods: We conducted a literature review of peer-reviewed publications in English on the clinical and epidemiological features of respiratory PASC in cohorts of 100 or more patients with a follow-up of four weeks or more after acute infection. Included studies reported the prevalence of persistent respiratory symptoms and/or the results of follow-up pulmonary function tests. Results: On our review included 14 studies across eight countries with a total of 2,380 patients. Subacute PASC was reported in 876 patients, and chronic PASC in 1,504 patients. The median age ranged from 44 to 67 years. The most common symptoms observed were fatigue (44%), dyspnea (40%), and cough (22%). Lung disease as a comorbidity was found in 13% of patients on average. Predominance of males was seen in all studies of subacute PASC and six out of eight studies of chronic PASC. The rates of comorbidities for subacute vs. chronic PASC were: hypertension 32% vs. 31%, cardiovascular disease 10% vs. 7%, diabetes mellitus 15% vs. 12%, kidney disease 7% vs. 4%, and lung disease 19% vs. 10%. Conclusion: Respiratory PASC seems to be more predominant as a chronic presentation, more common in male adults, and less common in older persons. Respiratory PASC is most often associated with fatigue, dyspnea, and cough. There was no strong correlation of severity of illness, acute respiratory distress syndrome, or intensive care unit admission with respiratory PASC

Diagnostic stewardship in infectious diseases:a continuum of antimicrobial stewardship in the fight against antimicrobial resistance

Antimicrobial resistance (AMR) has been exacerbated by the inappropriate use of diagnostics, leading to excessive prescription of antimicrobials, and is an imminent threat to global health. Diagnostic stewardship (DS) is an auxiliary to antimicrobial stewardship (AMS) and comprises ordering the right tests, for the right patient, at the right time. It also promotes the judicious use of rapid and novel molecular diagnostic tools to enable the initiation of proper antibiotic therapy, while avoiding excessive use of broad-spectrum antibiotics. Proper interpretation of test results is crucial to avoid overdiagnosis and excessive healthcare costs. Although many rapid diagnostic tools have been developed with a high diagnostic yield, they are often limited by accessibility, cost, and lack of knowledge regarding their use. Careful consideration of clinical signs and symptoms with knowledge of the local epidemiology are essential for DS. This enables appropriate interpretation of microbiological results. Multidisciplinary teams that include well trained professionals should cooperate to promote DS. Challenges and barriers to the implementation of DS are mostly caused by scarcity of resources and lack of trained personnel and, most importantly, lack of knowledge. The lack of resources is often due to absence of awareness of the impact that good medical microbiology diagnostic facilities and expertise can have on the proper use of antibiotics.</p

Infective Endocarditis after Transcatheter Aortic Valve Replacement: Challenges in the Diagnosis and Management

Although initially conceived for high-risk patients who are ineligible for surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR) is now recommended in a wider spectrum of indications, including among young patients. However, similar to SAVR, TAVR is also associated with a risk of infectious complications, namely, prosthetic valve endocarditis (PVE). As the number of performed TAVR procedures increases, and despite the low incidence of PVE post-TAVR, clinicians should be familiar with its associated risk factors and clinical presentation. Whereas the diagnosis of native valve endocarditis can be achieved straightforwardly by applying the modified Duke criteria, the diagnosis of PVE is more challenging given its atypical symptoms, the lower sensitivity of the criteria involved, and the low diagnostic yield of conventional echocardiography. Delay in proper management can be associated with increased morbidity and mortality. Therefore, clinicians should have a high index of suspicion and initiate proper work-up according to the severity of the illness, the underlying host, and the local epidemiology of the causative organisms. The most common causative pathogens are Gram-positive bacteria such as Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus spp., and Streptococcus spp. (particularly the viridans group), while less-likely causative pathogens include Gram-negative and fungal pathogens. The high prevalence of antimicrobial resistance complicates the choice of therapy. There remain controversies regarding the optimal management strategies including indications for surgical interventions. Surgical assessment is recommended early in the course of illness and surgical intervention should be considered in selected patients. As in other PVE, the duration of therapy depends on the isolated pathogen, the host, and the clinical response. Since TAVR is a relatively new procedure, the outcome of TAVR-PVE is yet to be fully understood

Antimicrobial Treatment of Pseudomonas aeruginosa Severe Sepsis

Pseudomonas aeruginosa is a pathogen often encountered in a healthcare setting. It has consistently ranked among the most frequent pathogens seen in nosocomial infections, particularly bloodstream and respiratory tract infections. Aside from having intrinsic resistance to many antibiotics, it rapidly acquires resistance to novel agents. Given the high mortality of pseudomonal infections generally, and pseudomonal sepsis particularly, and with the rise of resistant strains, treatment can be very challenging for the clinician. In this paper, we will review the latest evidence for the optimal treatment of P. aeruginosa sepsis caused by susceptible as well as multidrug-resistant strains including the difficult to treat pathogens. We will also discuss the mode of drug infusion, indications for combination therapy, along with the proper dosing and duration of treatment for various conditions with a brief discussion of the use of non-antimicrobial agents