Neumonia adquirida en la comunidad
Páginas: 18 (4322 palabras)
Publicado: 19 de agosto de 2012
26. Palacios G, Hornig M, et al. PLoS One 2009;4:e8540. 27. Kumar A, Zarychanski R, et al. Critically ill patients with 2009 influenza A(H1N1) infection in Canada. JAMA 2009;302:1872-9. 28. Gomez-Gomez A, Magana-Aquino M, et al. Emerg Infect Dis 2010;16:27-34. 29. Rello J, Rodriguez A, et al. Crit Care 2009;13:R148. 30. Treanor JJ. Chapter 165: Influenza Viruses, Including Avian Influenza andSwine Influenza. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7 ed: Churchill Livingstone; 2009. 31. Wright PF, Kirkland KB, Modlin JF. NEJM 2009;361:e112. 32. Fisman DN, Savage R, et al. NEJM 2009;361:2000-1. 33. Agarwal PP, Cinti S, Kazerooni EA. AJR Am J Roentgenol 2009;193:1488-93. 34. Cunha BA. S Int J Antimicrob Agents2009.
35. Cunha BA. J Clin Virol 2009. 36. Cunha B, Syed U, Strollo S. J Chemother 2009;21:584-9. 37. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388-416.
Disclosure of Financial Interests of authors and/or significant others
Melina Irizarry-Acosta, MD, is a fellow in theDivision of Infectious Diseases, Roger Williams Medical Center/Boston University School of Medicine. Yoram A. Puius, MD, PhD, is an attending physician in the Division of Infectious Diseases, Roger Williams Medical Center, and an Assistant Professor at the Boston University School of Medicine.
Melina Irizarry-Acosta, MD. No financial interests to disclose. Yoram A. Puius, MD. Consultant:Excelimmune, Inc. (Woburn, MA) for unrelated research
CORRESPONDENCE
Yoram A. Puius, MD, PhD Division of Infectious Diseases Roger Williams Medical Center 825 Chalkstone Avenue Providence, RI 02908 Phone: (401) 456-2437 E-mail: ypuius@rwmc.org
Community-Acquired Pneumonia In Children
Penelope H. Dennehy, MD
Community-acquired pneumonia
(CAP) is one of the most common infections encountered inpediatrics, with an annual incidence of approximately 40 cases per 1000 children in North America.1 Despite its frequency, CAP in children remains difficult to diagnose, evaluate, and manage because many pathogens may be responsible, co-infections occur frequently, clinical features may vary widely, and laboratory testing to support the diagnosis is limited.
ETIOLOGY
ACQUIRED
OFCOMMUNITYPNEUMONIA
Many pathogens cause pneumonia in children, including bacteria, viruses, and fungi. Because culture of lung parenchyma or pleural fluid requires an invasive procedure, most studies in children have relied on indirect methods such as rapid viral testing or polymerase chain reaction assay (PCR) on upper respiratory tract secretions, serology, and/or blood culture to identify the infectingpathogen. Studies that include an intensive search for etiology in hospitalized children with pneumonia identified a likely cause in up to 85% of cases, but an etiologic diagnosis is made in a much smaller proportion of outpatient cases. Due to a reluctance to perform invasive diagnostic procedures on young children, the epidemiology of CAP in children remains poorly defined.
The most commonetiologies of pneumonia vary with the age of the patient (Table 1). In neonates, group B streptococcus and gram-negative enteric bacteria are the most common bacterial pathogens and are generally acquired through vertical transmission.2 Viral pneumonia with cytomegalovirus and herpes simplex virus should be considered even without a suspicious maternal history. Chlamydia trachomatis infection, oncea common cause of infection in infants, has become much less common through prenatal screening and treatment of maternal infection. The most common cause of bacterial pneumonia in children older than 3 weeks is Streptococcus pneumoniae. Before the pneumococcal vaccine was introduced in 2000, Streptococcus pneumoniae accounted for 13 % to 28% of pediatric CAP.3 Postlicensure epidemiologic...
35. Cunha BA. J Clin Virol 2009. 36. Cunha B, Syed U, Strollo S. J Chemother 2009;21:584-9. 37. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388-416.
Disclosure of Financial Interests of authors and/or significant others
Melina Irizarry-Acosta, MD, is a fellow in theDivision of Infectious Diseases, Roger Williams Medical Center/Boston University School of Medicine. Yoram A. Puius, MD, PhD, is an attending physician in the Division of Infectious Diseases, Roger Williams Medical Center, and an Assistant Professor at the Boston University School of Medicine.
Melina Irizarry-Acosta, MD. No financial interests to disclose. Yoram A. Puius, MD. Consultant:Excelimmune, Inc. (Woburn, MA) for unrelated research
CORRESPONDENCE
Yoram A. Puius, MD, PhD Division of Infectious Diseases Roger Williams Medical Center 825 Chalkstone Avenue Providence, RI 02908 Phone: (401) 456-2437 E-mail: ypuius@rwmc.org
Community-Acquired Pneumonia In Children
Penelope H. Dennehy, MD
Community-acquired pneumonia
(CAP) is one of the most common infections encountered inpediatrics, with an annual incidence of approximately 40 cases per 1000 children in North America.1 Despite its frequency, CAP in children remains difficult to diagnose, evaluate, and manage because many pathogens may be responsible, co-infections occur frequently, clinical features may vary widely, and laboratory testing to support the diagnosis is limited.
ETIOLOGY
ACQUIRED
OFCOMMUNITYPNEUMONIA
Many pathogens cause pneumonia in children, including bacteria, viruses, and fungi. Because culture of lung parenchyma or pleural fluid requires an invasive procedure, most studies in children have relied on indirect methods such as rapid viral testing or polymerase chain reaction assay (PCR) on upper respiratory tract secretions, serology, and/or blood culture to identify the infectingpathogen. Studies that include an intensive search for etiology in hospitalized children with pneumonia identified a likely cause in up to 85% of cases, but an etiologic diagnosis is made in a much smaller proportion of outpatient cases. Due to a reluctance to perform invasive diagnostic procedures on young children, the epidemiology of CAP in children remains poorly defined.
The most commonetiologies of pneumonia vary with the age of the patient (Table 1). In neonates, group B streptococcus and gram-negative enteric bacteria are the most common bacterial pathogens and are generally acquired through vertical transmission.2 Viral pneumonia with cytomegalovirus and herpes simplex virus should be considered even without a suspicious maternal history. Chlamydia trachomatis infection, oncea common cause of infection in infants, has become much less common through prenatal screening and treatment of maternal infection. The most common cause of bacterial pneumonia in children older than 3 weeks is Streptococcus pneumoniae. Before the pneumococcal vaccine was introduced in 2000, Streptococcus pneumoniae accounted for 13 % to 28% of pediatric CAP.3 Postlicensure epidemiologic...
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