ISSN:0951-7375    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The laboratory diagnosis of infections of the respiratory tract is not an exact science, with many clinicians electing to empirically select antimicrobial therapy without the benefit of laboratory testing. With trained laboratory personnel and the proper selection of tests, accurate laboratory diagnosis is available. Progress is occurring most rapidly with molecular methods, such as polymerase chain reaction (PCR) testing. As molecular approaches are technically simplified and become less expensive, advances in the laboratory diagnosis of most respiratory tract infections caused by fastidious pathogens will occur. The diagnosis of non-fastidious bacteria, that require in-vitro antimicrobial testing, will continue to require conventional culture methods. New bronchoscopic methods, quantitative evaluation of cultures, and recognition of intracellular bacteria in stained smears do improve the usefulness of conventional culture and stain in the diagnosis of pneumonia.

ISSN:0951-7375    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Mycoplasma, Chlamydia and Legionella are the usual organisms considered to be the etiologic agents of ‘atypical’ pneumonia. Other microorganisms such as bacteria, viruses, parasites, fungi and mycobacteria can also present with atypical pneumonia manifestations. Outbreaks and isolated cases of respiratory viruses with atypical pneumonia presentations have been reported among immunocompetent and immunosuppressed patients. Severe infections due to these respiratory viruses alone or as a concomitant bacterial or viral infection have been observed. Additionally, in endemic areas, certain zoonotic infections may present as atypical pneumonia.

ISSN:0951-7375    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Legionellaspp. are significant causes of both community-acquired pneumonia and nosocomial pneumonia. More than 40 species ofLegionellahave now been identified. The spectrum of disease ranges from asymptomatic infection to serious disease, with two specific syndromes identified: Legionnaire's disease and Pontiac fever. Hospital-acquired infection arises from the presence ofLegionellain the hospital water supply. The optimal approach for the detection and prevention of nosocomial infection is debatable-whether or not periodic sampling of hospital water systems should be carried out in the absence of clinical cases is controversial. Newer macrolides or newer fluoroquinolone agents are the preferred therapy for serious diseases caused byLegionella.

ISSN:0951-7375    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The successful management of community-acquired pneumonia requires many management decisions, including a decision as to the site of care, the type and duration of antibiotic therapy, and a discharge decision for patients who require hospitalization. A number of recent studies have defined and tested criteria for some of the management decisions indicated above.

ISSN:0951-7375    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Community-acquired pneumonia has a significant impact upon healthcare in North America and worldwide. In the U.S. it is responsible for three to four million cases yearly and 78 000 deaths. It is not a homogeneous entity and it may be caused by a number of pathogens includingStreptococcus pneumoniae, the atypicals (Mycoplasma pneumoniae,Chlamydia pneumoniaeandLegionellaspecies)Haemophilus influenzaeand Gram-negative rods. While it is clear that directed therapy is the ideal, empiric therapy is likely to remain the norm for some time to come. This is because of limitations in current diagnostic techniques, the possibility of infection with co-pathogens and the broad spectrum of antimicrobial activity required to treat the various pathogens which may be responsible for infection in any given patient. Of great concern is the increase in the incidence of resistant pathogens seen in community-acquired pneumonia. Of particular significance are the isolates ofS. pneumoniaewhich display resistance to penicillin and macrolides although the exact clinical relevance has yet to be determined. New guidelines for the treatment of community-acquired pneumonia have been developed by the Infectious Disease Society of America which include the new fluoroquinolones. These agents offer the potential for monotherapy of community-acquired pneumonia in cases which previously required combination regimens such as a macrolide and a beta-lactam. There is great concern however, that these agents not be used inappropriately thereby hastening the emergence of resistance to the fluoroquinolone class of antimicrobials.

ISSN:0951-7375    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Illnesses caused by respiratory pathogens result in great loss of life, suffering and commitment of resources for treatment. That the suffering and loss of life can be prevented through immunization has already been clearly shown with existing vaccines, such as those forHaemophilus influenzaetype b,Streptococcus pneumoniae, and influenza. The emergence of drug-resistant pathogens is making reliance on therapy more expensive and perhaps less successful, accentuating the need to focus on prevention. Although several effective vaccines to prevent respiratory infections currently exist, they are underutilized globally. Improvements in immunogenicity, efficacy, and ease of administration, and lowering the costs of some of the existing vaccines would augment the potential for prevention worldwide. The greatest opportunities for the prevention of respiratory infections will rest with vaccines that will become available in the future.

ISSN:0951-7375    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0951-7375    

出版商:OVID    

年代:1999

数据来源: OVID