The aetiology of community-acquired pneumonia and implications for patient management.

Item does not contain fulltextPURPOSE: Understanding which pathogens are associated with clinical manifestation of community-acquired pneumonia (CAP) is important to optimise treatment. We performed a study on the aetiology of CAP and assessed possible implications for patient management in the Netherlands. METHODS: Patients with CAP attending the emergency department of a general hospital were invited to participate in the study. We used an extensive combination of microbiological techniques to determine recent infection with respiratory pathogens. Furthermore, we collected data on clinical parameters and potential risk factors. RESULTS: From November 2007 through January 2010, 339 patients were included. Single bacterial infection was found in 39% of these patients, single viral infection in 12%, and mixed bacterial-viral infection in 11%. Streptococcus pneumoniae was the most frequently identified pathogen (22%; n=74). Infection with atypical bacteria was detected in 69 (20%) of the patients. CONCLUSION: Initial empirical antibiotics should be effective against S. pneumoniae, the most common pathogen identified in CAP patients. The large proportion of patients with infection with atypical bacteria points to the need for improved diagnostic algorithms including atypical bacteria, especially since these atypical bacteria are not covered by the first-choice antibiotic treatment according to the recently revised Dutch guidelines on the management of CAP.1 oktober 201

Bestrijding van de nieuwe influenza A (H1N1): Deel I. Overzicht van de relevante virologische aspecten

In April 2009 a new influenza virus was discovered, which spread from Mexico to the rest of the world. The new influenza A (H1N1) virus is genetically related to swine flu viruses, and differs substantially from circulating human influenza viruses. It is able to spread from person to person. Because it is a completely new virus, there is probably little immunity in the population. The course of the infection is relatively mild, but the virus will mutate and it is not yet certain whether this will affect severity of the influenza. General practitioners have an important role in surveillance and treatment. The Community Health Services must be notified of any patients who are suspected of having the new influenza. Hygiene measures and administration of antiviral drugs to patients and their contacts may slow the spread. A delay in large-scale spread in the Netherlands allows time for the development of vaccines