Community-acquired pneumonia in adults: Guidelines for management
Infectious Diseases; Microbiology; united-states; Immunology; polymerase chain-reaction; resistant streptococcus-pneumoniae; legionnaires-disease; chlamydia-pneumoniae; aspiration; diagnostic fiberoptic bronchoscopy; hantavirus pulmonary syndrome; pneumococcal polysaccharide vaccine; pneumocystis-carinii pneumonia; transtracheal
This is part of the series of practice guidelines commissioned by the Infectious Diseases Society of America through its Practice Guidelines Committee. The purpose of this guideline is to provide assistance to clinicians in the diagnosis and treatment of community-acquired pneumonia, The targeted providers are internists and family practitioners. The targeted groups are immunocompetent adult patients. Criteria are specified for determining whether the inpatient or outpatient setting is appropriate for treatment. Differences from other guidelines written on this topic include use of laboratory criteria for diagnosis and approach to antimicrobial therapy. Panel members and consultants are experts in adult infectious diseases. The guidelines are evidence based where possible. A standard ranking system is used for the strength of the recommendations and the quality of the evidence cited in the literature reviewed. The document has been subjected to external review by peer reviewers as well as by the Practice Guidelines Committee and was approved by the IDSA Council. An executive summary and tables highlight the major recommendations. The guidelines will be listed on the IDSA home page at http://www.idsociety.org.
Bartlett J G; Breiman R F; Mandell L A; File T M
Clinical Infectious Diseases
1998
1998-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1086/513953" target="_blank" rel="noreferrer noopener">10.1086/513953</a>
Clinical characteristics of Chlamydia pneumoniae infection as the sole cause of community-acquired pneumonia.
*Chlamydophila pneumoniae/immunology; 80 and over; Adult; Aged; Antibodies; Bacterial/blood; Chlamydia Infections/blood/immunology/*microbiology/*physiopathology; Community-Acquired Infections/blood/immunology/*microbiology/physiopathology; Female; Humans; Male; Middle Aged; Pneumonia/blood/immunology/microbiology/*physiopathology
The clinical characteristics of 26 patients with community-acquired pneumonia due to Chlamydia pneumoniae as the only identified pathogen who required hospitalization were evaluated. Most patients (18) had reinfection based on serological results. The mean age of the patients was 55 years (38 years, patients with primary infection; 63 years, patients with reinfection), and the gender representation was equal. Generally, illness was mild and associated with limited temperature elevation and nonspecific symptoms. The presence of comorbid illnesses and the requirement of supplemental oxygen therapy were the most common criteria for hospital admission.
File T M Jr; Plouffe J F Jr; Breiman R F; Skelton S K
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
1999
1999-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1086/520227" target="_blank" rel="noreferrer noopener">10.1086/520227</a>
Risk factors for domestic acquisition of Legionnaires disease
community-acquired pneumonia; cooling-tower; evaporative condenser; General & Internal Medicine; hot; legionella-pneumophila serogroup-1; monoclonal-antibody; outbreak; potable water; tap water; united-states; water-systems
Background: Legionnaires disease is a common cause of adult pneumonia. Outbreaks of legionnaires disease have been well described, but little is known about sporadically occurring legionnaires disease, which accounts for most infections. Exposure to contaminated residential water sources is 1 plausible means of disease acquisition. Methods: Employing a matched case-control study design in 15 hospitals in 2 Ohio counties, we prospectively enrolled 146 adults diagnosed as having nonepidemic, community-acquired legionnaires disease and compared each with 2 hospital-based control patients, matched for age, sex, and underlying illness category. An interview regarding potential exposures was followed by a home survey that included sampling residential sources for Legionella. Interview and home survey data were analyzed to estimate the risk of acquiring legionnaires disease associated with various exposures. Results: Multivariate analysis showed that a nonmunicipal water supply (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.17-4.37), recent residential plumbing repair (OR, 2.39; 95% CI, 1.10-5.18), and smoking (OR, 3.48; 95% CI, 2.09-5.79) were independent risk factors for legionnaires disease. Univariate analysis suggested that electric (vs gas) water heaters (OR, 1.97; 95% CI, 1.10-3.52), working more than 40 hours weekly (OR, 2.13; 95% CI, 1.12-4.07), and spending nights away from home before illness (OR, 1.68; 95% CI, 1.03-2.74) were additional possible risk factors. Lower chlorine concentrations in potable water and lower water heater temperatures were associated with residential Legionella colonization. Conclusions: A proportion of sporadic cases of legionnaires disease may be residentially acquired and are associated with domestic potable water and disruptions in residential plumbing systems. Potential strategies to reduce legionnaires disease risk include consistent chlorination of potable water, increasing water heater temperatures, and limiting exposure to aerosols after domestic plumbing repairs.
Straus W L; Plouffe J F; File T M; Lipman H B; Hackman B H; Salstrom S J; Benson R F; Breiman R F; Baird I; Emerick J; Gianakopoulos G; Herbert M; Parsons J; Anderson C J; Bollin G E; Farkas S A; Francis S J; Gardner W G; Myers J P; Signs D J; Tan J S; Thomson R B; Barbaree J; Fields B; Morrill W; Moyenuddin M; Pruckler J; StJohn A
Archives of Internal Medicine
1996
1996-08
Journal Article
<a href="http://doi.org/10.1001/archinte.156.15.1685" target="_blank" rel="noreferrer noopener">10.1001/archinte.156.15.1685</a>