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The Role of Atypical Pathogens in Community-Acquired Pneumonia

The term atypical pneumonia was first used in 1938, and by the 1970s it was widely used to refer to pneumonia due to Mycoplasma pneumoniae, Legionella pneumophila (or other Legionella species), and Chlamydophila pneumoniae. However, in the purest sense all pneumonias other than the classic bacterial pneumonias are atypical. Currently many favor abolition of the term atypical pneumonia.

This review categorizes atypical pneumonia pathogens as conventional ones; viral agents and emerging atypical pneumonia pathogens. We emphasize viral pneumonia because with the increasing availability of multiplex polymerase chain reaction we can identify the agent(s) responsible for viral pneumonia. By using a sensitive assay for procalci...

Biomarkers and Community-Acquired Pneumonia: Tailoring Management with Biological Data

Community-acquired pneumonia (CAP) is the leading cause of death from infectious diseases worldwide, with an incidence of 0.3 to 0.5% in the adult population.

A new diagnostic and prognostic approach relies on evaluation of biomarkers as an expression of the host's inflammatory response against the microorganism. C-reactive protein (CRP), procalcitonin (PCT), and cytokines are the most frequently studied, whereas pro-adrenomedullin (pro-ADM), pro-vasopressin (pro-VNP), and others are currently obtaining promising results.

Their usefulness for diagnosis is limited, although PCT has been successfully used to guide prescription of antibiotics in patients with suspected CAP. Nevertheless, the accuracy of PCT in distinguishi...

Global Trends in Community-Acquired Pneumonia

The first series of manuscripts describe how several countries have developed large epidemiological databases to track the outcomes and microbiological evolution of patients with CAP. In addition, large global epidemiological studies have contributed to a better understanding of the changes and differences of care among continents, regions, countries, cities, and hospitals. Multiple risk factors are associated with the development of CAP, and several of these risk factors are associated with worse outcomes. Microbiology trends of typical and atypical pathogens are important in deciding on empirical antimicrobial therapies. There is also a rising concern for the development of antimicrobial resistance of common pathogens linked to patients with CAP. Significant progress has been made with newer technologies, such as genomics, proteomics, and metabolomics, which may bring important advances to the understanding of disease mechanisms and drug development.

Accurate assessment of disease severity in CAP patients at the time of clinical presentation is critical for clinicians managing patients with pneumonia. Therefore a good understanding of how to apply decision tools is paramount. In addition, rapid diagnostic methods and point of care testing with the use of biomarkers that may predict the severity of the disease, suggest when to remove or change antimicrobial therapies, and predict clinical outcomes are hot topics for care of patients with CAP.

Despite the best care possible and the incorporation of technological advances directed toward improving the implementation of evidence-based practices, some patients do not reach clinical stability and fail therapy. These patients with CAP carry the worst prognosis and account for significant resource utilization. The treatment of patients with CAP depends on the use of antimicrobial therapies and nonantimicrobial adjunctive therapies that have been shown to provide improvement in the care of patients with CAP. However, there is significant interest in new interventions that may immunomodulate and continue to improve patients' clinical outcomes.

Finally, despite appropriate treatments, patients with CAP continue to die after surviving the initial hospitalization or care. A section focusing on the impact of long-term outcomes for patients with CAP may help clinicians follow these patients and develop future strategies to improve long-term survival.

Global Changes in the Epidemiology of Community-Acquired Pneumonia

This article reviews the epidemiology of community-acquired pneumonia from a global perspective.

Major areas of epidemiological work include

  • disease surveillance to define the burden of disease and to document outbreaks,
  • identification of risk factors for a disease to optimize prevention strategies,
  • and comparisons of treatment effects to improve clinical outcomes for patients with the disease.

Community-Acquired Pneumonia Guidelines: A Global Perspective

Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality worldwide, and since 1993, guidelines for management have been available. The process, which first began in the United States and Canada, has now been implemented in numerous countries throughout the world, and often each geographic region or country develops locally specific recommendations.

It is interesting to realize that guidelines from different regions often interpret the same evidence base differently, and guidelines differ from one country to another, even though the bacteriology of CAP is often more similar than different from one region to another. One of the unique contributions of the 2007 US guidelines is the inclusion of quali...

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