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Background: Ventilator‐associated pneumonia (VAP) may be a particular concern in patients with severe coronavirus disease 2019 (COVID‐19). We aimed to determine the prevalence and etiology of VAP in critically ill COVID‐19 patients in a Danish intensive care unit (ICU) during the first three waves of the COVID‐19 pandemic and to study associations between dexamethasone (DXM) use and development of VAP. Methods: In an observational single‐center study patients were retrospectively screened for VAP including causative pathogens, use of DXM and commonly used antibiotics. Diagnosis of VAP required invasive mechanical ventilation (IMV) >48 h with presence of a new bacterial agent and clinical signs of infection. For analysis, common descriptive statistics were applied. Cox proportional hazards models were used to analyze the association between DXM use and VAP. Results: VAP was detected in 53/119 (44.5%) mechanically ventilated patients across all three COVID‐19 waves. Median length of IMV for VAP patients was 24 [15–41] days, and 3 out of 4 were males. VAP was most prevalent (47.0%) during the second wave. Common pathogens included Klebsiella pneumoniae (24.5%), Enterobacter aerogenes (17.0%) and Pseudomonas aeruginosa (13.2%), Staphylococcus aureus (13.2%), and Escherichia coli (13.2%). A change from Gram‐negative bacteria only to a combination of Gram‐positive and Gram‐negative bacteria was observed in the second wave compared to first. Use of DXM was not associated with VAP (adjusted hazard ratio 1.63 95% CI: 0.84–3.17). Conclusion: The prevalence of VAP was high across all three COVID‐19 waves and showed a different distribution of pathogens between the first and second wave. Use of DXM was not associated with VAP development. Further and larger studies are needed to understand the risk factors associated with VAP in patients with COVID‐19. [ABSTRACT FROM AUTHOR]

Importance: Community-acquired pneumonia (CAP) results in approximately 1.4 million emergency department visits, 740 000 hospitalizations, and 41 000 deaths in the US annually. Observations: Community-acquired pneumonia can be diagnosed in a patient with 2 or more signs (eg, temperature >38 °C or ≤36 °C; leukocyte count <4000/μL or >10 000/μL) or symptoms (eg, new or increased cough or dyspnea) of pneumonia in conjunction with consistent radiographic findings (eg, air space density) without an alternative explanation. Up to 10% of patients with CAP are hospitalized; of those, up to 1 in 5 require intensive care. Older adults (≥65 years) and those with underlying lung disease, smoking, or immune suppression are at highest risk for CAP and complications of CAP, including sepsis, acute respiratory distress syndrome, and death. Only 38% of patients hospitalized with CAP have a pathogen identified. Of those patients, up to 40% have viruses identified as the likely cause of CAP, with Streptococcus pneumoniae identified in approximately 15% of patients with an identified etiology of the pneumonia. All patients with CAP should be tested for COVID-19 and influenza when these viruses are common in the community because their diagnosis may affect treatment (eg, antiviral therapy) and infection prevention strategies. If test results for influenza and COVID-19 are negative or when the pathogens are not likely etiologies, patients can be treated empirically to cover the most likely bacterial pathogens. When selecting empirical antibacterial therapy, clinicians should consider disease severity and evaluate the likelihood of a bacterial infection—or resistant infection—and risk of harm from overuse of antibacterial drugs. Hospitalized patients without risk factors for resistant bacteria can be treated with β-lactam/macrolide combination therapy, such as ceftriaxone combined with azithromycin, for a minimum of 3 days. Systemic corticosteroid administration within 24 hours of development of severe CAP may reduce 28-day mortality. Conclusions: Community-acquired pneumonia is common and may result in sepsis, acute respiratory distress syndrome, or death. First-line therapy varies by disease severity and etiology. Hospitalized patients with suspected bacterial CAP and without risk factors for resistant bacteria can be treated with β-lactam/macrolide combination therapy, such as ceftriaxone combined with azithromycin, for a minimum of 3 days. This Review summarizes current evidence on pathogenesis, epidemiology, diagnosis, and treatment of community-acquired pneumonia and focuses on adults without immune-compromising conditions. [ABSTRACT FROM AUTHOR]

Background and Purpose: Influenza remains a significant global health concern, necessitating continuous research to understand its clinical manifestations and prognostic indicators. While the accurate diagnosis of pneumonia etiology is based on microbiological tests, clinical and radiological data can help narrow the differential diagnosis. This study, conducted at the Razi Educational and Medical Center in Ghaemshahr, aimed to comprehensively evaluate the radiological findings among patients diagnosed with influenza. Additionally, it sought to explore potential correlations between these radiological manifestations and various demographic and clinical characteristics. Materials and Methods: Using a prospective cohort design, the study enrolled individuals who were admitted to Razi Hospital in Ghaemshahr with symptoms indicative of influenza from 2018 to 2019. Upon admission, all patients underwent comprehensive CT scans within 24 hours to assess the extent and nature of pulmonary involvement. The data collected from these evaluations were analyzed statistically using SPSS software, with a significance level set at P<0.05. Results: The cohort consisted of 52 patients diagnosed with influenza, confirmed through both clinical assessments and laboratory tests. Among them, 30 were male (57.7%) and 22 were female (42.3%). Notably, 9 patients (17.3%) required admission to the intensive care unit (ICU) due to the severity of their condition. Of these ICU patients, 7 (77.8%) unfortunately succumbed to the influenza infection, highlighting the seriousness of this viral illness. Regarding the radiological assessments, the study found that while 13 patients (25%) showed normal findings on imaging studies, a significant majority of 39 patients (75%) exhibited varying degrees of pulmonary abnormalities. These abnormalities were characterized by a range of radiological manifestations, with alveolar infiltration, ground-glass opacities, and consolidation being the most common findings. Alveolar infiltration, observed in 14 patients (26.9%), emerged as a notable indicator of poorer prognosis among the influenza-infected cohort. The findings of this study underscore a significant correlation between abnormal lung imaging—particularly alveolar infiltration—and an unfavorable prognosis in patients with influenza. These radiological patterns serve as valuable prognostic markers, providing critical insights into the clinical course of the illness and potentially aiding in the formulation of strategic interventions. Conclusion: The study highlights the pivotal role of radiological assessments, particularly the identification of alveolar infiltration, in predicting outcomes among individuals with influenza. These findings emphasize the importance of using radiological evaluations as essential tools in clinical decision-making, enabling timely interventions and improving patient care in influenza management protocols. [ABSTRACT FROM AUTHOR]

Objectives: The aging population, including patients with superficial esophageal cancer, encounters critical dysphagia‐ and postoperative pneumonia‐related issues. Although endoscopic submucosal dissection (ESD) provides advantages over other modalities, older patients are at higher risk of postoperative pneumonia. Furthermore, the etiologies of pneumonia are complex and include patient‐ (such as sarcopenia) and treatment‐ (including ESD) related factors. Therefore, this study evaluated swallowing function in patients with superficial esophageal cancer and identified post‐ESD pneumonia‐associated factors. Methods: Comprehensive swallowing function and sarcopenia were evaluated in patients pre‐ESD and 2 months post‐ESD using high‐resolution manometry and several swallowing studies by multiple experts. The effects of mucosal resection and sarcopenia on swallowing function changes post‐ESD, the relationship between preoperative swallowing function and sarcopenia, and the factors influencing postoperative pneumonia were investigated. Results: Twenty patients were included in the study. Patients with preoperative sarcopenia had significantly lower pharyngeal/upper esophageal sphincter and tongue pressures than those without sarcopenia. However, ESD did not worsen pharyngeal or upper esophageal pressure. Post‐ESD pneumonia incidence tended to be higher in patients with sarcopenia than in those without sarcopenia. The lower upper esophageal sphincter‐integrated relaxation pressure (UES‐IRP) was a significant factor in pneumonia development. Furthermore, the receiver operating characteristic curve for UES‐IRP in pneumonia yielded an area under the curve of 0.82. Conclusions: Sarcopenia is associated with preoperative dysphagia, which increases post‐ESD pneumonia risk. Therefore, postoperative pneumonia incidence is expected to increase with an aging population, making preoperative sarcopenia and swallowing function evaluation crucial. [ABSTRACT FROM AUTHOR]

Introduction: In patients with suspected pneumonia who are tested with respiratory culture and multiplex PCR, the potential added benefit of next-generation sequencing technologies is unknown. Methods: This was a single-center, retrospective study in which residual bronchoalveolar lavage (BAL) specimens were retrieved from hospitalized patients. We compared its research-use-only Respiratory Pathogen Illumina Panel (RPIP) results to culture and BioFire® FilmArray Pneumonia Panel (BioFire® PN) results from critically ill patients. Results: In total, 47 BAL specimens from 47 unique patients were included. All BAL samples were tested with culture and multiplex PCR. In total, 38 of the 47 BALs were consistent with a clinical picture of pneumonia per chart review. Additional testing of the 38 samples with the RPIP identified a new bacterium in 20 patients, a new virus in 4 patients, a new bacterium plus virus in 4 patients, and no additional organisms in 10 patients. In 17 (44.5%) of these patients, the RPIP results could have indicated an antibiotic addition. Compared with cultures, the RPIP had an overall sensitivity of 64% and specificity of 98%, with a 0% sensitivity for fungus and 14% sensitivity for mycobacteria. Compared with BioFire® PN, the RPIP was 70% sensitive and 99% specific, with a 74% sensitivity for bacteria and 33% sensitivity for viruses. The RPIP was 29% more sensitive for HAP/VAP bacterial targets compared with CAP. Conclusions: Emerging NGS technologies such as the RPIP may have a role in identifying the etiology of pneumonia, even when patients have BAL culture and multiplex PCR results available. Similar to prior studies evaluating RPIP, our study showed this platform lacked sensitivity when compared with cultures, particularly for fungi and mycobacteria. However, the high specificity of the test can be leveraged when clinicians are seeking to rule out certain infections. [ABSTRACT FROM AUTHOR]

Background. In December 2019, the World Health Organization was notified about cases of pneumonia of unknown etiology originating in Wuhan, Hubei province, China. Hashimoto’s thyroiditis and other thyroid disorders including Graves’ disease affects almost 5 % of the general population. Hashimoto’s thyroiditis is a chronic disease in which the body interprets the thyroid gland and its hormone products as threats, therefore producing special antibodies that target thyroid cells, thereby destroying them. It may present with hypothyroidism or hyperthyroidism and with or without goiter. Basic questions in the consideration of a clinical case: what is COVID-19, and health complications? What concerns are related to pain in the front of the neck? How much has COVID-19 affected the occurrence of thyroid problems? Сase report. A 40-year-old man presented to the infectious disease clinic with a fever (37.9 °C), sore throat, body aches, and lethargy for 3 days on January 25, 2021. Due to the clinical features and the COVID-19 pandemic, a nasopharyngeal swab was used for sampling, and SARS-CoV-2 test was positive (mRNA in real time RT-PCR). On the 13th day, the patient’s general condition improved, but he complained of sore throat. On re-examination, we noticed a slight tenderness in the neck in the thyroid area. On thyroid ultrasound, a heterogeneous thyroid gland with ill-defined bilateral hypoechoic areas revealed subacute thyroiditis. The same patient presented to the infectious clinic with a fever (37.1 °C), sore throat, body aches and fatigue on June 28, 2022. After 5 days, the test for SARS-CoV-2 was negative, but, after one month of recovery, blood samples were analyzed to identify the functional state of the thyroid gland, and we obtained results with high values of thyroid-stimulating hormone. Conclusions. COVID-19 is a new disease for which larger-scale research is still ongoing, potential complications of COVID-19 and organ involvement are still being elucidated in the literature. Pain in the front of the neck, which can be combined with the upper part of the respiratory tract, especially in the conditions of COVID-19, should not be overlooked and requires further examinations. Subacute thyroiditis is a rare complication of COVID-19 that should be considered, especially in the progression of COVID-19 and the appearance of Hashimoto’s thyroiditis. [ABSTRACT FROM AUTHOR]

Air embolism is a condition that often goes unnoticed, and although it is potentially life-threatening, it is rarely reported. The condition usually develops iatrogenically and resorbs spontaneously, although complications such as pulmonary edema and parenchymal destruction can develop. In our case, in lung tomography images taken 10 hours apart, the air seen in the pulmonary artery and right atrium disappeared, while areas of increasing consolidation were identified in the left lung. It is thought that air embolisms may be a cause of pneumonia etiologies in patients undergoing intravenous (IV) procedures, while other studies have referred to the condition, considered pneumonia, as an inflammatory process that develops due to the destruction following an air embolism. There is a need to investigate the frequency of complications and pneumonia in cases that develop air embolisms following IV procedures. [ABSTRACT FROM AUTHOR]

Background: Bacterial pneumonia can affect all age groups, but people with weakened immune systems, young children, and the elderly are at a higher risk. Streptococcus pneumoniae, Klebsiella pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa are the most common causative agents of pneumonia, and they have developed high MDR in recent decades in Ethiopia. This systematic review and meta-analysis aimed to determine the pooled prevalence of bacterial pneumonia and multidrug resistance in Ethiopia. Methods: The articles were searched extensively in the electronic databases and grey literature using entry terms or phrases. Studies meeting the eligibility criteria were extracted in MS Excel and exported for statistical analysis into STATA version 14 software. The pooled prevalence of bacterial pneumonia and multidrug resistance were calculated using a random-effects model. Heterogeneity was assessed by using the I2 value. Publication bias was assessed using a funnel plot and Egger's test. A sensitivity analysis was done to assess the impact of a single study on the pooled effect size. Result: Of the 651 studies identified, 87 were eligible for qualitative analysis, of which 11 were included in the meta-analysis consisting of 1154 isolates. The individual studies reported prevalence of bacterial pneumonia ranging from 6.19 to 46.3%. In this systematic review and metanalysis, the pooled prevalence of bacterial pneumonia in Ethiopia was 37.17% (95% CI 25.72–46.62), with substantial heterogeneity (I2 = 98.4%, p < 0.001) across the studies. The pooled prevalence of multidrug resistance in bacteria isolated from patients with pneumonia in Ethiopia was 67.73% (95% CI: 57.05–78.40). The most commonly isolated bacteria was Klebsiella pneumoniae, with pooled prevalence of 21.97% (95% CI 16.11–27.83), followed by Streptococcus pneumoniae, with pooled prevalence of 17.02% (95% CI 9.19–24.86), respectively. Conclusion: The pooled prevalence of bacterial isolates from bacterial pneumonia and their multidrug resistance were high among Ethiopian population. The initial empirical treatment of these patients remains challenging because of the strikingly high prevalence of antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Introduction: Pulmonary fibrosis (PF), a type of interstitial pneumonia with complex etiology and high mortality, is characterized by progressive scarring of the alveolar interstitium and myofibroblastic lesions. In this study, we screened for potential biomarkers in PF and clarified the role of the lncRNA-miRNA-mRNA ceRNA network in the inhibitory effect of SRL-4 on PF. Methods: Healthy male SPF SD rats were randomly divided into three groups, namely, CON, MOD, and SRL-4. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed to determine the biological functions of the target genes. A visualized lncRNA-miRNA-mRNA ceRNA network was constructed using Cytoscape, while key genes in the network were identified using the cytoNCA plugin. Results: Seventy-four differentially expressed lncRNAs and 118 differentially expressed mRNAs were identified. Gene Ontology analysis revealed that the target genes were mainly enriched in the cell membrane and in response to organic substances, while Kyoto Encyclopedia of Genes and Genomes analysis showed that the target genes were mainly enriched in the AMPK, PPAR, and cAMP signaling pathways. We elucidated a ceRNA axis, namely, Plcd3-OT1/rno-miR150-3p/Fkbp5, with potential implications in PF. Key genes, such as AABR07051308.1-201, F2rl2-OT1, and LINC3337, may be important targets for the treatment of PF, while the AMPK, PPAR, and cAMP signaling pathways are potential key targets and important pathways through which SRL-4 mitigates PF. Conclusion: Our findings suggest that SRL-4 improves PF by regulating the lncRNA-miRNA-mRNA network. [ABSTRACT FROM AUTHOR]

Introduction: In 2012, the World Health Organization revised treatment guidelines for childhood pneumonia with lower chest wall indrawing (LCWI) but no 'danger signs', to recommend home-based treatment. We analysed data from children hospitalized with LCWI pneumonia in the Pneumonia Etiology Research for Child Health (PERCH) study to identify sub-groups with high odds of mortality, who might continue to benefit from hospital management but may not be admitted by staff implementing the 2012 guidelines. We compare the proportion of deaths identified using the criteria in the 2012 guidelines, and the proportion of deaths identified using an alternative set of criteria from our model. Methods: PERCH enrolled a cohort of 2189 HIV-negative children aged 2–59 months who were admitted to hospital with LCWI pneumonia (without obvious cyanosis, inability to feed, vomiting, convulsions, lethargy or head nodding) between 2011–2014 in Kenya, Zambia, South Africa, Mali, The Gambia, Bangladesh, and Thailand. We analysed risk factors for mortality among these cases using predictive logistic regression. Malnutrition was defined as mid-upper-arm circumference <125mm or weight-for-age z-score <-2. Results: Among 2189 cases, 76 (3·6%) died. Mortality was associated with oxygen saturation <92% (aOR 3·33, 1·99–5·99), HIV negative but exposed status (4·59, 1·81–11·7), moderate or severe malnutrition (6·85, 3·22–14·6) and younger age (infants compared to children 12–59 months old, OR 2·03, 95%CI 1·05–3·93). At least one of three risk factors: hypoxaemia, HIV exposure, or malnutrition identified 807 children in this population, 40% of LCWI pneumonia cases and identified 86% of the children who died in hospital (65/76). Risk factors identified using the 2012 WHO treatment guidelines identified 66% of the children who died in hospital (n = 50/76). Conclusions: Although it focuses on treatment failure in hospital, this study supports the proposal for better risk stratification of children with LCWI pneumonia. Those who have hypoxaemia, any malnutrition or those who were born to HIV positive mothers, experience poorer outcomes than other children with LCWI pneumonia. Consistent identification of these risk factors should be prioritised and children with at least one of these risk factors should not be managed in the community. [ABSTRACT FROM AUTHOR]

Background: Motor neuron disease (MND) is a fatal neurodegenerative disorder that leads to progressive loss of motor neurons. Chlamydia psittaci (C. psittaci) is a rare etiology of community-acquired pneumonia characterized primarily by respiratory distress. We reported a case of C. psittaci pneumonia complicated with motor neuron disease (MND). Case presentation: A 74-year-old male was referred to the Shaoxing Second Hospital at January, 2022 complaining of fever and fatigue for 2 days. The patient was diagnosed of MND with flail arm syndrome 1 year ago. The metagenomic next-generation sequencing (mNGS) of sputum obtained through bedside fiberoptic bronchoscopy showed C. psittaci infection. Then doxycycline was administrated and bedside fiberoptic bronchoscopy was performed to assist with sputum excretion. Computed Tomography (CT) and fiberoptic bronchoscopy revealed a significant decrease in sputum production. On day 24 after admission, the patient was discharged with slight dyspnea, limited exercise tolerance. One month later after discharge, the patient reported normal respiratory function, and chest CT showed significant absorption of sputum. Conclusions: The mNGS combined with bedside fiberoptic bronchoscopy could timely detect C. psittaci infection. Bedside fiberoptic bronchoscopy along with antibiotic therapy may be effective for C. psittaci treatment. [ABSTRACT FROM AUTHOR]

Conventional methods used to determine pneumonia pathogens are characterized by low sensitivity and long turnaround times. Introducing new tests with better parameters in patients at higher risk of infections is highly anticipated. The results of the conventional quantitative culture method (CM) in determining the bacterial etiology of pneumonia were compared with the results of the Pneumonia plus Panel test (PNP; BioFire® Diagnostics, USA) in 79 samples of bronchoalveolar lavage (BAL). Materials were collected from 79 patients with suspected pneumonia treated in an oncologic hospital due to solid tumors. Only 16/79 BAL samples (20.3%) were true positive (TP) for bacterial etiology in CM vs. 27/79 samples (34.2%) true positive in the PNP test. The total agreement between methods of interpreting the result (positive or negative) was 84.8%. The most prevalent pathogens in both methods were Staphylococcus aureus, followed by Escherichia coli, Pseudomonas aeruginosa, and Haemophilus influenzae. The PNP test identified several respiratory pathogens that were not grown in culture. The semiquantitative value reported by the PNP test was higher than that reported by culture. The PNP test vs. combined test (PNP test and CM methods) demonstrated positive predictive value (PPV) and negative predictive value (NPV) values of 100.0% and 98.1%, and the sensitivity and specificity were 96.4% and 100.0%. The PNP test is a good tool for determining the etiology of bacterial pneumonia and may support the care of an oncologic patient. However, further large-sample studies are needed to research in strictly defined groups of oncologic patients. [ABSTRACT FROM AUTHOR]

Background: Patients with pneumonia exhibit similar clinical presentations despite having different causative organisms; thus, a rapid and easy test is needed to differentiate between the diseases. Here, we use lung ultrasound to discriminate between causative organisms in correlation with other diagnostic modalities. Methods: This descriptive cross-sectional study was carried out on 67 patients diagnosed with atypical pneumonia admitted at Ain-Shams University hospitals in the period from July 2019 to June 2021. Study population was divided into three groups according to the causative agent based on the results of PCR: Group 1 included 23 patients (influenza A), group 2 included 30 patients (COVID-19), and group 3 included 14 patients (atypical organisms). Included patients underwent lung ultrasound scan via a 12-zone scanning protocol and CT scan with 24 h in between. The present study was approved by the ethical committee at our institution. Results: The mean age ranged from 39.93 ± 19.26 SD to 60.3 ± 13.02 SD years; 64.17% of them were males. There was also a highly statistically significant difference between the three groups as regard B-lines and thickened pleural line being higher among group 2; 100% of cases had B-lines in their chest ultrasound assessment, while thickened pleural line was found in 53.3% of cases. Dynamic air bronchogram was found with higher percentage in group 3 (71.4%) with a highly significant association. Higher mean Soldati score was associated with more severe disease among cases with viral pneumonia. Conclusions: Lung ultrasound may be used as an aiding tool to estimate the etiology of atypical pneumonia. It can be useful during pandemics of acute respiratory diseases for rapid triage and stratification of patients as through calculation of modified Soldati score and detection of the most common finding. Also, modified Soldati score correlates with disease severity. [ABSTRACT FROM AUTHOR]

Worldwide, conjugated pneumococcal vaccines (PCVs) have proven effective against invasive pneumococcal disease, but non-invasive pneumonia is a major cause of mortality in young children and serotypes vary geographically, affecting effectiveness. We analyze nationwide death certificate data between 2003–2017 to assess the impact of PCVs on pneumonia mortality among young children from Peru. We report descriptive statistics and perform timeseries analysis on annual mortality rates (AMRs) and monthly frequencies of pneumonia deaths. Children under 5 years of age accounted for 6.2% (n = 10,408) of all pneumonia deaths (N = 166,844), and 32.3% (n = 3363) were children between 1–4 years of age, of which 95.1% did not report pneumonia etiology. Comparing periods before and after PCV introduction in 2009, mean AMRs dropped 13.5% and 26.0% for children between 1–4 years of age (toddlers/preschoolers), and children under 1 year of age (infants), respectively. A moderate correlation (Spearman's r = 0.546, p < 0.01) in the monthly frequency of pneumonia deaths was estimated between both age groups. Quadratic regression suggests a change in direction around 2005 (highest pneumonia mortality) for both age groups, but percentage change analysis identified an inflection point in 2013 for infants only, not for toddlers/preschoolers, suggesting that the impact of PCVs might be different for each age group. [ABSTRACT FROM AUTHOR]

Respiratory pathology in pigs is a widespread issue in global pig farming. The etiology of pneumonia varies and can significantly differ between regions. Periodically, new pathogens inducing respiratory diseases in pigs, including respiratory organs, are discovered worldwide. Therefore, the aim of our work was to determine the microbiome structure of pneumonia in domestic pigs in Ukraine. Fragments of lung tissue were collected for research from deceased pigs with signs of respiratory pathology. A total of 87 cases of pig pneumonia from 62 pig farms located in 20 different regions of Ukraine were investigated. Using the qPCR method, genes of 13 microorganisms were identified: PCV 2, PCV 3, SIV type A, SIV type D, PRRSV EU, A. pleuropneumoniae, A. suis, M. hyopneumoniae, M. hyorhinis, S. suis, P. multocida, B. bronchiseptica, and G. parasuis. It has been determined that the pneumonia microbiome in growing pigs is represented by a co-infection of 3-6 microorganisms, while in fattening pigs, it consists of 4-7 microorganisms. The maximum number of microorganisms in the pneumonia focus in both groups comprises 9 taxa. Some cases have been identified where none of the microorganisms were detected. The most prevalent microorganisms causing pig pneumonia are PCV2, G. parasuis, S. suis, M. hyorhinis, and P. multocida, whereas the least common are PCV3, PRRSV EU, and SIV type A. There is no evidence of SIV type D circulation among domestic pigs in Ukraine. There was found out the association for verified pneumonia events of growing pigs with dominant viruses PCV2 and PRRSV UA while an average concentration ranging from 108 to 109 genome equivalents per gram of lung tissue. In fattening pigs, PCV2 and A. pleuropneumoniae are most prevalent, with their average quantity varying from 107 to 109 genome equivalents per gram of lung tissue. PCV2 in most pneumonia cases appeared as a monoviral infection. Viral co-infections were identified involving PCV2, PRRSV UA, and PCV3. The least common respiratory virus is SIV type A, detected in only 2% of affected lungs. Bacterial pneumonia without viral involvement in growing pigs is significantly less common than in fattening pigs, but the bacterial spectrum is common for both groups, represented by M. hyorhinis, S. suis, and G. parasuis. [ABSTRACT FROM AUTHOR]

Background: Patients with fungal pneumonias sometimes progress to acute respiratory distress syndrome (ARDS). Mortality has been reported as high as 60% to 90% in this group. Venovenous extracorporeal membrane oxygenation (VV-ECMO) can be used to support such patients, however, outcomes are not well understood. Patients and Methods: This was a retrospective study across the four adult ECMO centers in Minnesota for one decade (2012–2022). The outcomes of interest were duration of ECMO, survival rate, and complications. Data were extracted from the electronic medical record and analyzed using descriptive statistics. Results: Fungal pneumonia was the etiology of ARDS in 22 of 422 (5%) adults supported with VV-ECMO during the 10-year study period. Median patient age was 43 years (interquartile range [IQR], 35–56) and 68% were male. By type of fungal infection, 16 (72%) had blastomycosis, five (22%) had pneumocystis, and one (5%) had cryptococcus. Of the 16 patients with blastomycosis two were immunosuppressed whereas all five of the pneumocystis patients were immunosuppressed. The overall survival rate was 73%; most patients with blastomycosis (67%) and pneumocystis (80%) survived to hospital discharge. The duration of ECMO support was greater for the pneumocystis group (median, 30 days; IQR, 21–43) compared with blastomycosis (median, 10 days; IQR, 8–18). Conclusions: Our findings support the use of VV-ECMO for ARDS caused by fungal pneumonias in select immunocompetent and immunocompromised patients. Although survival was high, patients with pneumocystis required longer ECMO runs. [ABSTRACT FROM AUTHOR]

COVID-19 has been a diagnostic and therapeutic challenge. It has marked a paradigm shift when considering other types of pneumonia etiology. We analyzed the biomarkers related to endothelial damage and immunothrombosis in COVID-19 in comparison to community-acquired pneumonia (CAP) through a case–control study of 358 patients with pneumonia (179 hospitalized with COVID-19 vs. 179 matched hospitalized with CAP). Endothelial damage markers (endothelin and proadrenomedullin), neutrophil extracellular traps (NETs) (citrullinated-3 histone, cell-free DNA), and platelet activation (soluble P-selectin) were measured. In-hospital and 1-year follow-up outcomes were evaluated. Endothelial damage, platelet activation, and NET biomarkers are significantly higher in CAP compared to COVID-19. In-hospital mortality in COVID-19 was higher compared to CAP whereas 1-year mortality and cardiovascular complications were higher in CAP. In the univariate analysis (OR 95% CIs), proADM and endothelin were associated with in-hospital mortality (proADM: CAP 3.210 [1.698–6.070], COVID-19 8.977 [3.413–23.609]; endothelin: CAP 1.014 [1.006–1.022], COVID-19 1.024 [1.014–1.034]), in-hospital CVE (proADM: CAP 1.623 [1.080–2.439], COVID-19 2.146 [1.186–3.882]; endothelin: CAP 1.005 [1.000–1.010], COVID-19 1.010 [1.003–1.018]), and 1-year mortality (proADM: CAP 2.590 [1.644–4.080], COVID-19 13.562 [4.872–37.751]; endothelin: CAP 1.008 [1.003–1.013], COVID-19 1.026 [1.016–1.037]). In conclusion, COVID-19 and CAP showed different expressions of endothelial damage and NETs. ProADM and endothelin are associated with short- and long-term mortality. [ABSTRACT FROM AUTHOR]

Pulmonary fibrosis (PF) is a fibrotic interstitial pneumonia with poor prognosis and limited treatment methods. Inhibition of integrin α V β 6 expression could prevent pulmonary fibrosis, however, a phase II clinical trial of α V β 6 -blocking antibody treating PF stopped prematurely due to low bioavailability and toxic side effects of systematic administration. Here, we describe a micro-invasive percutaneous transthoracic and hydrogen peroxide-responsive microneedle composed of degradable gel for smart delivery of integrin α v β 6 -blocking antibody which has the advantages of rapid response, excellent biocompatibility, protection of bioactivity, high tissue permeation and specific targeting to lesions. This microneedle could partially release integrin α v β 6 -blocking antibodies when exposed to hydrogen peroxide generated during PF, thus reducing activation of the pro-fibrotic factor TGF-β1 from its latent precursor and showing excellent therapeutic efficacy for PF. Idiopathic pulmonary fibrosis (IPF) is a rare fibrotic interstitial pneumonia with unknown etiology, poor prognosis, and limited treatment methods. Inhibition of integrin α V β 6 expression could prevent pulmonary fibrosis, however, a phase II clinical trial of α V β 6 -blocking antibody treating IPF stopped prematurely due to low bioavailability and toxic side effects of systematic administration. Here, we describe a micro-invasive percutaneous transthoracic and hydrogen peroxide-responsive microneedle composed of degradable gel for smart delivery of integrin α v β 6 -blocking antibody which has the advantages of rapid response, excellent biocompatibility, protection of bioactivity, high tissue permeation and specific targeting to lesions. This microneedle could partially release integrin α v β 6 -blocking antibodies when exposed to hydrogen peroxide generated during IPF, thus reduce activation of the pro-fibrotic factor TGF-β1 from its latent precursor and show excellent therapeutic efficacy for IPF. [Display omitted] [ABSTRACT FROM AUTHOR]

Immunodeficiency plays a crucial role in the etiology of recurrent pneumonia. Humoral immunodeficiencies account for approximately 60% of all primary immunodeficiencies, and in such patients, antibody deficiencies are the leading cause of immunodeficiency. That study aimed to investigate the effect of immunoglobulin levels on the frequency of pneumonia episodes and the relationship between immunoglobulin levels and risk factors for pneumonia in children aged 1-5 years with recurrent pneumonia caused by humoral immunity. The prospective study included a total of 92 randomly selected children aged 1-5 years, comprising a group of 70 patients hospitalized due to pneumonia and a group of 22 healthy controls who had no chronic diseases and infections. Body height and weight were significantly lower in the patient group compared to the control group (p=0.012 and p=0.022, respectively). The mean breastfeeding duration was significantly lower (p=0.001), and the prevalence of exposure to environmental tobacco smoking (ETS) was significantly higher (p=0.018) compared to the control group. In the patient group, 65% of the participants had a deficiency of an immunoglobulin isotope and/or IgG subclasses in isolation or combination. IgG4 deficiency was the most common deficiency (38.5%), followed by IgG1 (21.4%), IgG2 (18.5%), IgA (15.7%), and IgG3 deficiency (12.8%), respectively. Our results indicated that inadequate breastfeeding and environmental tobacco smoking prepare the ground for pneumonia, a significant cause of morbidity and mortality in children, and contributes to the recurrence of this disease. Humoral immunodeficiencies, a significant underlying cause of recurrent pneumonia that leads to growth retardation, may have different clinical manifestations. [ABSTRACT FROM AUTHOR]

PURPOSE: To implement the technical feasibility of an AI-based software prototype optimized for the detection of COVID-19 pneumonia in CT datasets of the lung and the differentiation between other etiologies of pneumonia. METHODS: This single-center retrospective case–control-study consecutively yielded 144 patients (58 female, mean age 57.72 ± 18.25 y) with CT datasets of the lung. Subgroups including confirmed bacterial (n = 24, 16.6%), viral (n = 52, 36.1%), or fungal (n = 25, 16.6%) pneumonia and (n = 43, 30.7%) patients without detected pneumonia (comparison group) were evaluated using the AI-based Pneumonia Analysis prototype. Scoring (extent, etiology) was compared to reader assessment. RESULTS: The software achieved an optimal sensitivity of 80.8% with a specificity of 50% for the detection of COVID-19; however, the human radiologist achieved optimal sensitivity of 80.8% and a specificity of 97.2%. The mean postprocessing time was 7.61 ± 4.22 min. The use of a contrast agent did not influence the results of the software (p = 0.81). The mean evaluated COVID-19 probability is 0.80 ± 0.36 significantly higher in COVID-19 patients than in patients with fungal pneumonia (p < 0.05) and bacterial pneumonia (p < 0.001). The mean percentage of opacity (PO) and percentage of high opacity (PHO ≥ −200 HU) were significantly higher in COVID-19 patients than in healthy patients. However, the total mean HU in COVID-19 patients was −679.57 ± 112.72, which is significantly higher than in the healthy control group (p < 0.001). CONCLUSION: The detection and quantification of pneumonia beyond the primarily trained COVID-19 datasets is possible and shows comparable results for COVID-19 pneumonia to an experienced reader. The advantages are the fast, automated segmentation and quantification of the pneumonia foci. [ABSTRACT FROM AUTHOR]

COVID-19 is a rapidly proliferating transmissible virus that substantially impacts the world population. Consequently, there is an increasing demand for fast testing, diagnosis, and treatment. However, there is a growing need for quick testing, diagnosis, and treatment. In order to treat infected individuals, stop the spread of the disease, and cure severe pneumonia, early covid-19 detection is crucial. Along with covid-19, various pneumonia etiologies, including tuberculosis, provide additional difficulties for the medical system. In this study, covid-19, pneumonia, tuberculosis, and other specific diseases are categorized using Sharpened Cosine Similarity Network (SCS-Net) rather than dot products in neural networks. In order to benchmark the SCS-Net, the model's performance is evaluated on binary class (covid-19 and normal), and four-class (tuberculosis, covid-19, pneumonia, and normal) based X-ray images. The proposed SCS-Net for distinguishing various lung disorders has been successfully validated. In multiclass classification, the proposed SCS-Net succeeded with an accuracy of 94.05% and a Cohen's kappa score of 90.70%; in binary class, it achieved an accuracy of 96.67% and its Cohen's kappa score of 93.70%. According to our investigation, SCS in deep neural networks significantly lowers the test error with lower divergence. SCS significantly increases classification accuracy in neural networks and speeds up training. [ABSTRACT FROM AUTHOR]

Idiopathic pulmonary fibrosis (IPF) is a form of chronic and irreversible fibrosing interstitial pneumonia of unknown etiology. Although antifibrotic treatments have shown a reduction of lung function decline and a slow disease progression, IPF is characterize by a very high mortality. Emerging evidence suggests that IPF increases the risk of lung carcinogenesis. Both diseases show similarities in terms of risk factors, such as history of smoking, concomitant emphysema, and viral infections, besides sharing similar pathogenic pathways. Lung cancer (LC) diagnosis is often difficult in IPF patients because of the diffuse lung injuries and abnormalities due to the underlying fibrosis. This is reflected in the lack of optimal therapeutic strategies for patients with both diseases. For this purpose, we performed a proteomic study on bronchoalveolar lavage fluid (BALF) samples from IPF, LC associated with IPF (LC-IPF) patients, and healthy controls (CTRL). Molecular pathways involved in inflammation, immune response, lipid metabolism, and cell adhesion were found for the dysregulated proteins in LC-IPF, such as TTHY, APOA1, S10A9, RET4, GDIR1, and PROF1. The correlation test revealed a relationship between inflammation- and lipid metabolism-related proteins. PROF1 and S10A9, related to inflammation, were up-regulated in LC-IPF BAL and serum, while APOA1 and APOE linked to lipid metabolism, were highly abundant in IPF BAL and low abundant in IPF serum. Given the properties of cytokine/adipokine of the nicotinamide phosphoribosyltransferase, we also evaluated its serum abundance, highlighting its down-regulation in LC-IPF. Our retrospective analyses of BAL samples extrapolated some potential biomarkers of LC-IPF useful to improve the management of these contemporary pathologies. Their differential abundance in serum samples permits the measurement of these potential biomarkers with a less invasive procedure. [ABSTRACT FROM AUTHOR]

Background: This study aims to evaluate the etiology in cases of non-resolving pneumonia using FOB Non-resolving pneumonia is a challenging clinical condition that requires more investigation. It accounts for 15% of inpatient pulmonary consultations. A delay in diagnosis and treatment may lead to a rise in mortality by 3% to 5%. Material And Methods: A cross-sectional study was done over a period of 22 months. A total of 50 cases of non-resolving pneumonia were included. A complete history was taken and a clinical examination was done. All were subjected to CECT chest and investigations which were required for diagnosis. FOB and guided procedures were done for all patients and samples were sent to the laboratory. Result: In this study, bacterial pneumonia (32%) was found to be the commonest etiology of non-resolving pneumonia, followed by Tuberculosis (22%), malignancy (16%) and fungal pneumonia (6%). In 24% of patients, the results were inconclusive. Conclusion: Non-resolving pneumonia is often an area of clinical dilemma. FOB is an extremely useful investigation. [ABSTRACT FROM AUTHOR]

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Background: Pneumonia is a leading cause of mortality in children <5 years globally. Early identification of hospitalized children with pneumonia who may fail antibiotics could improve outcomes. We conducted a secondary analysis from the Malawi CPAP IMPACT trial evaluating risk factors for antibiotic failure among children hospitalized with pneumonia. Methods: Participants were 1–59 months old with World Health Organization-defined severe pneumonia and hypoxemia, severe malnutrition, and/or HIV exposure/infection. All participants received intravenous antibiotics per standard care. First-line antibiotics were benzylpenicillin and gentamicin for five days. Study staff assessed patients for first-line antibiotic failure daily between days 3–6. When identified, patients failing antibiotics were switched to second-line ceftriaxone. Analyses excluded children receiving ceftriaxone and/or deceased by hospital day two. We compared characteristics between patients with and without treatment failure and fit multivariable logistic regression models to evaluate associations between treatment failure and admission characteristics. Results: From June 2015–March 2018, 644 children were enrolled and 538 analyzed. Antibiotic failure was identified in 251 (46.7%) participants, and 19/251 (7.6%) died. Treatment failure occurred more frequently with severe malnutrition (50.2% (126/251) vs 28.2% (81/287), p<0.001) and amongst those dwelling ≥10km from a health facility (22.3% (56/251) vs 15.3% (44/287), p = 0.026). Severe malnutrition occurred more frequently among children living ≥10km from a health facility than those living <10km (49.0% (49/100) vs 35.7% (275/428), p = 0.014). Children with severe malnutrition (adjusted odds ratio (aOR) 2.2 (95% CI 1.52, 3.24), p<0.001) and pre-hospital antibiotics ((aOR 1.47, 95% CI 1.01, 2.14), p = 0.043) had an elevated aOR for antibiotic treatment failure. Conclusion: Severe malnutrition and pre-hospital antibiotic use predicted antibiotic treatment failure in this high-risk severe pneumonia pediatric population in Malawi. Our findings suggest addressing complex sociomedical conditions like severe malnutrition and improving pneumonia etiology diagnostics will be key for better targeting interventions to improve childhood pneumonia outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Patients with myasthenia gravis (MG) are prone to the development of pneumonia due to the long-term immunotherapies they receive and a tendency for aspiration. Pneumonia remains a risk factor for MG worsening and is the most prevalent cause of mortality in MG patients. Classification of the pathogens involved and exploration of the risk factors for mechanical ventilation (MV) could aid in improving clinical outcomes. Methods: Between January 2013 and October 2022, we performed an inpatient database review for MG patients with pneumonia concurrence in a tertiary research center specializing in neuromuscular disorders. The clinical and microbiological characteristics of 116 MG patients with pneumonia were retrospectively analyzed. Results: In our cohort, 90.32% (112/124) of organisms were bacteria and 42.86% (48/112) of pathogenic bacteria were carbapenem-resistant. A high abundance of Epstein-Barr virus (EBV) was detected using next-generation sequencing (NGS) in 12 patients, while cytomegalovirus (CMV) was detected in 8 patients. Non-fermentative Gram-negative bacilli were the most prevalent microorganisms, in which ampicillin, sulfamethoxazole-trimethoprim (SMZTMP), piperacillin, cefoperazone, ceftazidime, and cefepime may have an antiinfectious effect. Moreover, peripheral lymphocyte percentage [odds ratio (OR) 0.88, 95% CI 0.75-0.96, p = 0.02] and serum globulin (OR 1.16, 95% CI 1.02-1.35, p = 0.03) were significantly associated with the risk of MV demand. Discussion: Our identification of the microbial etiology of pneumonia in MG patients may provide future perspectives on accurate antibiotic options and enable early interventions when risk factors are present. [ABSTRACT FROM AUTHOR]

Introduction. The diagnosis of pulmonary infection and the identification of pathogens are still clinical challenges in immunocompromised patients. Metagenomic next-generation sequencing (mNGS) has emerged as a promising infection diagnostic technique. However, its diagnostic value in immunocompromised patients needs further exploration. Purposes. This study was to evaluate the diagnostic value of mNGS compared with comprehensive conventional pathogen tests (CTs) in the etiology of pneumonia in immunocompromised patients and immunocompetent patients. Methods. We retrospectively reviewed 53 patients who were diagnosed with pneumonia from May 2019 to June 2021. There were 32 immunocompromised patients and 21 immunocompetent patients with pneumonia who received both mNGS and CTs. The diagnostic performance was compared between mNGS and CTs in immunocompromised patients, using the composite diagnosis as the reference standard. And, the diagnostic value of mNGS for mixed infections was further analyzed. Results. Compared to immunocompetent patients, the most commonly pathogens, followed by Cytomegalovirus, Pneumocystis jirovecii and Klebsiella pneumoniae in immunocompromised patients. Furthermore, more mixed infections were diagnosed, and bacterial-fungal-virus coinfection was the most frequent combination (43.8%). mNGS can detect more types of pathogenic microorganisms than CTs in both groups (78.1% vs. 62.5%, P = 0.016 and 57.1% vs. 42.9%, P = 0.048). The overall diagnostic positive rate of mNGS for pathogens was higher in immunocompromised patients (P = 0.002). In immunocompromised patients, a comparable diagnostic accuracy of mNGS and CTs was found for bacterial, fungal, and viral infections and coinfection. mNGS had a much higher sensitivity for bacterial infections (92.9% vs. 50%, P < 0.001) and coinfections (68.8% vs. 48.3%, P < 0.05), and it had no significant advantage in the detection of fungal infections, mainly due to the high sensitivity for Pneumocystis jirovecii in both groups. Conclusion. mNGS is more valuable in immunocompromised patients and exhibits apparent advantages in detecting bacterial and mixed infections. It may be an alternative or complementary diagnostic method for the diagnosis of complicated infections in immunocompromised patients. [ABSTRACT FROM AUTHOR]

Purpose: to assess the relationship of platelet variables with the etiology, severity of community-acquired pneumonia in children and the main biomarkers of systemic inflammation.Object and methods. The study included 65 children aged 9 months to 16 years 11 months with community-acquired pneumonia, who were treated at the clinic of Pediatric Research and Clinical Center for Infectious Diseases and the St. Olga City Children’s Hospital. Upon admission, the children underwent: complete blood count using a hematology analyzer (with the assessment of platelet parameters such as mean platelet volume, platelet distribution width, platelet large cell ratio), blood biochemistry (with the assessment of the C-reactive protein level), chest X-ray with radiographs in two projections. All children were examined for a wide range of pathogens of community-acquired pneumonia: respiratory viruses, S. pneumoniae, H. influenzae type b, M. pneumoniae, C. pneumoniae. The severity of pneumonia was assessed using the modified Respiratory Index of Severity in Children. Depending on the probable etiology, 4 groups of communityacquired pneumonia were identified: bacterial, viral, mycoplasma, and others.The results of the study. No significant differences in platelet variables depending on the etiology of pneumonia were found. In mycoplasma pneumonia, platelet variables are inversely proportional to the total white blood cell count. During the infectious process, all patients showed a significant increase in platelet count. The platelet count on admission directly correlates with the absolute white blood cell count and absolute neutrophil count. There are no significant correlations of platelet count and C-reactive protein concentration.Conclusion. There were no significant differences in platelet count depending on the etiology and severity of pediatric pneumonia. There are features of platelet variables in mycoplasma pediatric pneumonia.

Pneumonia is a common cause of morbidity and mortality and is most often caused by bacterial pathogens. COVID-19 is characterized by lung infection with potential progressive organ failure. The systemic consequences of both disease on the systemic blood metabolome are not fully understood. The aim of this study was to compare the blood metabolome of both diseases and we hypothesize that plasma metabolomics may help to identify the systemic effects of these diseases. Therefore, we profiled the plasma metabolome of 43 cases of COVID-19 pneumonia, 23 cases of non-COVID-19 pneumonia, and 26 controls using a non-targeted approach. Metabolic alterations differentiating the three groups were detected, with specific metabolic changes distinguishing the two types of pneumonia groups. A comparison of venous and arterial blood plasma samples from the same subjects revealed the distinct metabolic effects of pulmonary pneumonia. In addition, a machine learning signature of four metabolites was predictive of the disease outcome of COVID-19 subjects with an area under the curve (AUC) of 86 ± 10%. Overall, the results of this study uncover systemic metabolic changes that could be linked to the etiology of COVID-19 pneumonia and non-COVID-19 pneumonia. [ABSTRACT FROM AUTHOR]

Consistent clinical observations of characteristic findings of COVID-19 pneumonia on chest X-rays have attracted the research community to strive to provide a fast and reliable method for screening suspected patients. Several machine learning algorithms have been proposed to find the abnormalities in the lungs using chest X-rays specific to COVID-19 pneumonia and distinguish them from other etiologies of pneumonia. However, despite the enormous magnitude of the pandemic, there are very few instances of public databases of COVID-19 pneumonia, and to the best of our knowledge, there is no database with annotation of abnormalities on the chest X-rays of COVID-19 affected patients. Annotated databases of X-rays can be of significant value in the design and development of algorithms for disease prediction. Further, explainability analysis for the performance of existing or new deep learning algorithms will be enhanced significantly with access to ground-truth abnormality annotations. The proposed COVID Abnormality Annotation for X-Rays (CAAXR) database is built upon the BIMCV-COVID19+ database which is a large-scale dataset containing COVID-19+ chest X-rays. The primary contribution of this study is the annotation of the abnormalities in over 1700 frontal chest X-rays. Further, we define protocols for semantic segmentation as well as classification for robust evaluation of algorithms. We provide benchmark results on the defined protocols using popular deep learning models such as DenseNet, ResNet, MobileNet, and VGG for classification, and UNet, SegNet, and Mask-RCNN for semantic segmentation. The classwise accuracy, sensitivity, and AUC-ROC scores are reported for the classification models, and the IoU and DICE scores are reported for the segmentation models. [ABSTRACT FROM AUTHOR]

Community-acquired pneumonia (CAP) severely affects pediatric hospitalizations. This study assessed the contribution of CAP to hospitalizations, its etiology in relationship with age, and the inflammatory markers. Between 2013 and 2018, 1064 CAP patients were hospitalized and diagnosed with bacterial/possibly bacterial pneumonia (BP), viral/possibly viral pneumonia (VP) and atypical pneumonia (AP). The etiology was confirmed using blood/pleural fluid culture/polymerase chain reaction (PCR), rapid antigen test/PCR in nasopharyngeal swabs, or serological studies. CAP accounted for 9.9% of hospitalizations and 14.8% of patient days. BP was diagnosed in 825 (77.5%), VP in 190 (17.9%), and AP in 49 (4.6%) cases; the confirmed etiology (n = 209; 20%) included mostly influenza (39%; n = 82), respiratory syncytial virus (RSV, 35%; n = 72), and Mycoplasma pneumoniae (19%; n = 39). VP frequency decreased with age (41% in < 3 mo to 9% in ≥ 60 mo), in contrast to AP (13% in ≥ 60 mo). Among the analyzed parameters, the best differentiating potential was shown by: C-reactive protein (CRP, AUCBP-VP = 0.675; 95% CI: 0.634–0.715), procalcitonin (AUCBP-AP = 0.73; 95% CI: 0.67–0.794), and CRP/procalcitonin (AUCAP-VP = 0.752; 95% CI: 0.67–0.83); a good positive predictive value (88.8%, 98.3%, and 91.6%, respectively) but a low negative predictive value (29.5%, 13.1%, and 40.7%, respectively) was observed. CAP influences hospital patient days more than the crude number of patients would suggest. On a clinical basis, BP is mainly recognized, although viral pneumonia is confirmed most often. RSV and influenza are responsible for a huge percentage of hospitalized cases, as well as M. pneumoniae in children aged ≥ 5 years. Serum inflammatory markers may help differentiate etiological factors. [ABSTRACT FROM AUTHOR]

Introduction. Before the introduction of vaccination to protect children from pneumonia, Streptococcus pneumoniae and Haemophilus influenzae type B (HiB) were the most frequent aetiological agents causing bacterial pneumonia in children under five years old. However, the etiology of childhood pneumonia appears to be changing and nonvaccine- type S. pneumoniae, non-typeable H. influenzae, and Staphylococcus aureus are becoming more relevant. Objective. We conducted a systematic review aimed at identifying the common causes of bacterial pneumonia in children in sub-Saharan Africa. Methods. We searched PubMed, Web of Science and African Index Medicus and included primary studies conducted since January 2010 that reported on the bacterial causes of pneumonia in children under five from sub-Saharan Africa. We extracted data items (about the study setting, pneumonia diagnosis, sampling, microbiological methods, and etiological agents) as well as study quality indicators. Results. Streptococcus pneumoniae was the most common bacteria in blood cultures from children with pneumonia (8%, 95% CI: 4-14%), and H. influenzae was second (3%, 95% CI: 1-17%). Children's nasopharynx commonly contained S. pneumoniae (66%), Moraxella catarrhalis (62%), and H. influenzae (44%). Conclusion. S. pneumoniae and H. influenzae cause bacterial pneumonia in sub-Saharan African children. Our review also highlights the prevalence of potentially pathogenic bacteria in the nasopharynx of children under five and calls for more research into how nasopharyngeal colonization causes pneumonia. [ABSTRACT FROM AUTHOR]

In December 2019, a group of people in Wuhan city of Hubei province of China were found to be affected by an infection called dark etiology pneumonia. The outbreak of this pneumonia infection was declared a deadly disease by the China Center for Disease Control and Prevention on January 9, 2020, named Novel Coronavirus 2019 (nCoV-2019). This nCoV- 2019 is now known as COVID-19. There is a big list of infections of this coronavirus which is present in the form of a big family. This virus can cause several diseases that usually develop with a serious problem. According to the World Health Organization (WHO), 2019-nCoV has been placed as the modern generation of Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) coronaviruses, so COVID-19 can repeatedly change its internal genome structure to extend its existence. Understanding and accurately predicting the mutational properties of the genome structure of COVID-19 can forma good leadership role in preventing and fighting against coronavirus. In this research paper, an analytical approach has been presented which is based on the k-means cluster technique of machine learning to find the clusters over the mutational properties of the COVID-19 viruses' complete genome. This method would be able to act as a promising tool to monitor and track pathogenic infections in their stable and local genetics/hereditary varieties. This paper identifies five main clusters of mutations with k = 5 as best in most cases in the coronavirus that could help scientists and researchers develop disease control vaccines for the transformation of coronaviruses. [ABSTRACT FROM AUTHOR]

Community-acquired pneumonia (CAP) has been brought to the forefront of global health priorities due to the COVID-19 pandemic. However, classification of viral versus bacterial pneumonia etiology remains a significant clinical challenge. To this end, we have engineered a panel of activity-based nanosensors that detect the dysregulated activity of pulmonary host proteases implicated in the response to pneumonia-causing pathogens and produce a urinary readout of disease. The nanosensor targets were selected based on a human protease transcriptomic signature for pneumonia etiology generated from 33 unique publicly available study cohorts. Five mouse models of bacterial or viral CAP were developed to assess the ability of the nanosensors to produce etiology-specific urinary signatures. Machine learning algorithms were used to train diagnostic classifiers that could distinguish infected mice from healthy controls and differentiate those with bacterial versus viral pneumonia with high accuracy. This proofof-concept diagnostic approach demonstrates a way to distinguish pneumonia etiology based solely on the host proteolytic response to infection. [ABSTRACT FROM AUTHOR]

Background: Current approaches for pathogen identification in community-acquired pneumonia (CAP) remain suboptimal, leaving most patients without a microbiological diagnosis. If better diagnostic tools were available for differentiating between viral and bacterial CAP, unnecessary antibacterial therapy could be avoided in viral CAP patients. Methods: In 156 adults hospitalized with CAP classified to have bacterial, viral, or mixed viral-bacterial infection based on microbiological testing or both microbiological testing and procalcitonin (PCT) levels, we aimed to identify discriminatory host transcriptional signatures in peripheral blood samples acquired at hospital admission, by applying Dual-color-Reverse-Transcriptase-Multiplex-Ligation-dependent-Probe-Amplification (dc-RT MLPA). Results: In patients classified by microbiological testing, a 9-transcript signature showed high accuracy for discriminating bacterial from viral CAP (AUC 0.91, 95% CI 0.85-0.96), while a 10-transcript signature similarly discriminated mixed viral-bacterial from viral CAP (AUC 0.91, 95% CI 0.86-0.96). In patients classified by both microbiological testing and PCT levels, a 13-transcript signature showed excellent accuracy for discriminating bacterial from viral CAP (AUC 1.00, 95% CI 1.00-1.00), while a 7-transcript signature similarly discriminated mixed viral-bacterial from viral CAP (AUC 0.93, 95% CI 0.87-0.98). Conclusion: Our findings support host transcriptional signatures in peripheral blood samples as a potential tool for guiding clinical decision-making and antibiotic stewardship in CAP. [ABSTRACT FROM AUTHOR]

Objective and design: The existing biological models of diffuse alveolar damage (DAD) in mice have many shortcomings. To offset these shortcomings, we have proposed a simple, nonsurgical, and reproducible method of unilateral total damage of the left lung in ICR mice. This model is based on the intrabronchial administration of a mixture of bacterial lipopolysaccharide (LPS) from the cell wall of S. enterica and α-galactosylceramide (inducing substances) to the left lung. Methods: Using computer tomography of the lungs with endobronchial administration of contrast material, we have been able to perform an operative intravital verification of the targeted delivery of the inducer. The model presented is characterized by more serious and homogeneous damage of the affected lung compared to the existing models of focal pneumonia; at the same time, our model is characterized by longer animal survival since the right lung remains intact. Results: The model is also characterized by diffuse alveolar damage of the left lung, animal survival of 100%, abrupt increases in plasma levels of TNFa, INFg, and IL-6, and significant myocardial overload in the right heart. It can be used to assess the efficacy of innovative drugs for the treatment of DAD and ARDS as the clinical manifestations that are developed in patients infected with SARS-CoV-2. Morphological patterns of lungs in the noninfectious ("sterile") model of DAD induced by LPS simultaneously with α-galactosylceramide (presented here) and in the infectious model of DAD induced by SARS-CoV-2 have been compared. Conclusion: The DAD model we have proposed can be widely used for studying the efficacy of candidate molecules for the treatment of infectious respiratory diseases, such as viral pneumonias of different etiology, including SARS-CoV-2. [ABSTRACT FROM AUTHOR]

Introduction: A 15-year-old patient is taken by his parents to the emergency department of a tertiary care health institution for a severe respiratory problem. In the emergency room, after the clinical examination supported by diagnostic aids, it was decided to admit him for medical treatment due to severe pneumonia of an etiology to be defined. During hospitalization, it is found that the patient suffers from acquired immunodeficiency syndrome (AIDS), which is explained to his parents and the patient. The parents ask the diagnosis not to be revealed to prevent their son from being discriminated against. The patient dies during hospitalization and the information that the parents reveal to their relatives and acquaintances is that the cause of death was leukemia. During a multicenter investigative process designed to evaluate the behavior of the disease in the last ten years, one of the research assistants, taking data from a clinical history, finds that the patient, who was his acquaintance, had died of AIDS and not of leukemia and proceeds to reveal this information in his social environment, which causes great pain and discomfort to the parents, who claim the institution for the violation of the confidential handling of sensitive information of their son. The case is analyzed by the research ethics committee (REC) of the institution and other instances. [ABSTRACT FROM AUTHOR]

Community pneumonia (CP) is an acute lung infection, community- acquired, a form of pneumonia that develops in patients who were not hospitalized in the last 30 days or who didn’t live in a retirement home. Community pneumonia continues to be an important cause of morbidity and mortality (CP is the second most frequent hospitalization cause and the most frequent infectious cause of death), and it can be caused by bacteria, viruses or fungi. More than 100 microorganisms have been involved in the etiology of community pneumonia. Regardless the utilized technique for identifying the etiological agent, it was proven that Streptococcus pneumoniae is still the main cause of CP, although, with the introduction of antibiotics, the percentage of pneumococcal pneumonia has begun to decrease. Haemophilus influenzae is the second cause, followed by Moraxella catarrhalis. Other bacterial agents that cause community pneumonia are represented by Staphylococcus aureus, Enterobacteriaceae and atypical microorganisms (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila). Less frequent, there were isolated Streptococcus pyogenes, species from the group of viridans streptococci and Neisseria meningitidis. The use of molecular method, polymerase chain reaction, improved the etiological diagnosis of viral pneumonia caused by influenza and parainfluenza viruses, rhinoviruses, respiratory syncytial virus, human metapneumovirus, adenoviruses and coronaviruses, being noticed the relatively high frequency of bacterial/viral infections. Modern molecular techniques can simplify and improve the process of the correct identification of causal agents of community pneumonia. [ABSTRACT FROM AUTHOR]

Background: Viral pneumonias are a major cause of childhood mortality. Proper management needs early and accurate diagnosis. This study objective is to investigate the viral etiologies of pneumonia in children. Results: This prospective study enrolled 158 and 101 patients in the first and second year, respectively, and their mean age was 4.72 ± 2.89. Nasopharyngeal swabs were collected and subjected to virus diagnosis by reverse transcription polymerase chain reaction (RT-PCR). Viral etiologies of pneumonia were evidenced in 59.5% of the samples in the first year, all of them were affirmative for influenza A, 2 samples were affirmative for Human coronavirus NL63, and one for Human coronavirus HKU1. In the second year, 87% of patients had a viral illness. The most prevalent agents are human metapneumovirus which was detected in 44 patients (43.6%) followed by human rhinovirus in 35 patients (34.7%) and then parainfluenza–3 viruses in 33 patients (32.7%), while 14 patients had a confirmed diagnosis for both Pan coronavirus and Flu-B virus. Conclusions: Viral infection is prevalent in the childhood period; however, the real magnitude of viral pneumonia in children is underestimated. The reverse transcriptase polymerase chain reaction has to be a vital tool for epidemiological research and is able to clear the gaps in-between clinical pictures and final diagnoses. [ABSTRACT FROM AUTHOR]

Simple Summary: Hospital-acquired pneumonia (HAP) imposes public health threats because of its high morbidity and mortality rate. Accordingly, this study aimed to evaluate the diagnostic performance of the multiplexed BioFire FilmArray Pneumonia Panel plus (BFPP) for the rapid detection of various clinically relevant respiratory pathogens and genetic markers among 50 patients admitted with HAP to an intensive care unit (ICU) in a tertiary care hospital in Egypt. In comparison to standard culture methods, BFPP showed an overall sensitivity and specificity of 100% and 90%, respectively, with the identification of 11 viral targets (22%) among the tested specimens. The BFPP semi-quantitative analysis showed a concordance rate of 47.4% among positive culture specimens. For the examination of the antibiotic resistance genes, BFPP showed a positive percent agreement (PPA), a negative percent agreement (NPA) and an overall percent agreement (OPA), reaching 97%, 95%, and 95%, respectively, with standard antibiotic sensitivity testing. According to the obtained results, BFPP has the potential to enhance the rapid microbiological diagnosis of HAP cases, tailor appropriate antibiotic therapy, apply antimicrobial stewardship programs, and implement effective infection control measures. Hospital-acquired pneumonia (HAP) is a substantial public health issue that is associated with high mortality rates and is complicated by an arsenal of microbial etiologies, expressing multidrug-resistant phenotypes, rendering relatively limited therapeutic options. BioFire FilmArray Pneumonia Panel plus (BFPP) is a simple multiplexed PCR system that integrates sample preparation, nucleic acid extraction, amplification, and analysis of microbial etiology, with a turnaround time of about one hour. In comparison to standard culture methods, BFPP is simpler, easier to perform, and can simultaneously detect the most common pathogens involved in lower respiratory tract infections (34 targets). Accordingly, we evaluated the diagnostic performance of the multiplexed BFPP for the rapid detection of 27 clinically relevant respiratory pathogens and 7 genetic markers among 50 HAP cases admitted to the intensive care unit (ICU), who submitted mini-bronchoalveolar (mBAL) specimens. In comparison to standard culture methods, BFPP showed an overall sensitivity of 100% [95% CI; 90–100] and overall specificity of 90% [95% CI; 87.4–92.5] among all the tested bacterial targets. BFPP identified 11 viral targets (22%) among the tested specimens. The BFPP semi-quantitative analysis showed a concordance rate of 47.4% among positive culture specimens. For the investigation of the antibiotic resistance genes, BFPP showed a positive percent agreement (PPA), a negative percent agreement (NPA), and an overall percent agreement (OPA), reaching 97% [95% CI; 90–100], 95% [95% CI; 91.5–97], and 95% [95% CI; 93–97], respectively, with standard antibiotic sensitivity testing. In conclusion, BFPP has the potential to enhance the rapid microbiological diagnosis of HAP cases, and could aid in tailoring appropriate antibiotic therapies. [ABSTRACT FROM AUTHOR]

• Induced sputum (IS) is used in children to study chronic respiratory diseases. • A respiratory pathogen in IS was identified in 72.1% children with pneumonia. • IS is an adequate and feasible sample to determine the etiology of pneumonia. • IS is safe, well tolerated, and has higher diagnostic yield compared with other samples. This study aimed to evaluate the utility of induced sputum (IS) for the diagnosis of community-acquired pneumonia (CAP) in pediatric population. This cross-sectional study included pediatric population aged between 1 month and 17 years who were hospitalized with a diagnosis of CAP in 13 hospitals in Colombia, in whom an IS sample was obtained. Gram staining, aerobic bacterial and mycobacterial culture tests, and polymerase chain reaction (PCR) for 6 atypical bacteria and 15 respiratory viruses were performed. We evaluated the quality of IS samples. IS samples were collected in 516 of 525 children included in this study. The median age was 32 months, 38.6% were younger than 2 years, and 40.9% were between 2 and 5 years. Two patients had transient hypoxemia during the procedure. The quality of the IS obtained was good in 48.4% and intermediate in 24.5%. Identification of a respiratory pathogen was achieved with an IS sample (with Gram staining, culture test, and PCR) in 372 of 516 children with CAP. Our study shows that IS is an adequate sample for the diagnosis of CAP in pediatric population that required hospitalization. The procedure was safe, well tolerated, and with better diagnostic yields compared with the rest of the samples obtained. [ABSTRACT FROM AUTHOR]

At the end of December 2019, the Wuhan Municipal Health Commission, revealed several cases of pneumonia of unknown etiology. Later, this etiology was called the coronavirus disease 2019 (COVID-19). COVID-19 disease is rapidly spreading around the globe, affected millions of people, compelling governments to take serious actions. Due to this deadly disease, a number of deaths have been occurred and still increasing exponentially. In the practice and application of big data sciences, it is always of interest to provide the best description of the data. In this present article, the event background, symptoms, and preventions from COVID-19 are discussed. The steps were taken by the Chinese government to control the COVID-19 has also been discussed. Up to date, details, and data of daily discovered cases, total discovered cases, daily deaths, and total deaths around the world are presented. Moreover, a new statistical distribution is introduced to provide the best characterization of the survival times of the patients affected by the COVID-19 in China. By analyzing the survival times of the COVID-19 patient's data, it is showed that the new model provides a closer fit to COVID-19 events. [ABSTRACT FROM AUTHOR]

Background: Bacillus Calmette-Guérin (BCG) vaccination has recently been found to have beneficial effects among children infected other than Mycobacterium tuberculosis. Due to the paucity of data on the outcomes of children who had successful BCG vaccination following Expanded Programme on Immunization (EPI) schedule, we aimed to investigate the characteristics of such children and their outcomes who were hospitalized for severe malnutrition. Methods: A prospective observational study was conducted to determine the viral etiology of pneumonia in severely malnourished children those were admitted to the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) between April 2015 and December 2017, constituted the study population. Using a case-control design for the analysis, children having BCG vaccination prior hospital admission were treated as cases (n = 611) and those without vaccination, constituted as controls (n = 83). Bi-variate analysis was conducted using socio-demographic, clinical, laboratory, and treatment characteristics on admission and outcomes during hospitalization. Finally, log-linear binomial regression analysis was done to identify independent impact of BCG vaccination. Results: The cases more often presented with older age, have had lower proportion of maternal illiteracy, higher rate of breastfeeding, severe wasting and lower rate of hypoglycemia, compared to the controls. The cases were also found to have lower risk of severe sepsis and deaths, compared to the controls (for all, p<0.05). However, in log-linear binomial regression analysis, after adjusting for potential confounders, BCG vaccination following EPI schedule (RR:0.54; 95%CI = 0.33–0.89; p = 0.015) and breastfeeding (RR:0.53; 95%CI = 0.35–0.81; p = 0.003) were found to be protective for the development of severe sepsis. Conclusion: BCG vaccination and breastfeeding were found to be protective for the development of severe sepsis in hospitalized severely malnourished under-five children which underscores the importance of continuation of BCG vaccination at birth and breastfeeding up to two years of age. [ABSTRACT FROM AUTHOR]

COVID-19 is a pathology detected by the outbreak of cases of atypical pneumonia of unknown etiology in Wuhan, China in 2019 and has spread worldwide, causing severe acute respiratory syndrome. The morbidity and mortality of this pathology are high in Mexico, becoming a priority to implement initiatives that allow modulating the current course of this pathology. Vitamin D has an important immune role against respiratory infections, and its deficiency has been related to the pathogenesis of the virus; mortality from COVID-19 is complex due to other factors that intervene in its spread and appearance of complications. However, the study of vitamin D supplementation and its relationship with the outcome of this disease should be considered. [ABSTRACT FROM AUTHOR]

Bacterial pneumonia is one of the most serious public health issues owing to its medical and economic costs, which result in increased morbidity and mortality in people of all ages around the world. Furthermore, antimicrobial resistance has risen over time, and the advent of multi-drug resistance in GNB complicates therapy and has a detrimental impact on patient outcomes. The current review aimed to summarize bacterial pneumonia with an emphasis on gram-negative etiology, pathogenesis, risk factors, resistance mechanisms, treatment updates, and vaccine concerns to tackle the problem before it causes a serious consequence. In conclusion, the global prevalence of GNB in CAP was reported 49.7% to 83.1%, whereas in VAP patients ranged between 76.13% to 95.3%. The most commonly reported MDR-GNB causes of pneumonia were A. baumannii, K. pneumoniae, and P. aeruginosa, with A. baumannii isolated particularly in VAP patients and the elderly. In most studies, ampicillin, tetracyclines, amoxicillin-clavulanic acid, cephalosporins, and carbapenems were shown to be highly resistant. Prior MDR-GNB infection, older age, previous use of broad-spectrum antibiotics, high frequency of local antibiotic resistance, prolonged hospital stays, ICU admission, mechanical ventilation, and immunosuppression are associated with the MDR-GNB colonization. S. maltophilia was reported as a severe cause of HAP/VAP in patients with mechanically ventilated and having hematologic malignancy due to its ability of biofilm formation, site adhesion in respiratory devices, and its intrinsic and acquired drug resistance mechanisms. Effective combination therapies targeting PDR strains and drug-resistant genes, antibiofilm agents, gene-based vaccinations, and pathogen-specific lymphocytes should be developed in the future. [ABSTRACT FROM AUTHOR]

Object: Interstitial lung disease (ILD) is a specific form of chronic fibrosing interstitial pneumonia with various etiology. The severity and progression of ILD usually predict the poor outcomes of ILD. Otherwise, Krebs von den Lungen-6 (KL-6) is a potential immunological biomarker reflecting the severity and progression of ILD. This meta-analysis is to clarify the predictive value of elevated KL-6 levels in ILD. Method: EBSCO, PubMed, and Cochrane were systematically searched for articles exploring the prognosis of ILD published between January 1980 and April 2021. The Weighted Mean Difference (WMD) and 95% Confidence Interval (CI) were computed as the effect sizes for comparisons between groups. For the relationship between adverse outcome and elevated KL-6 concentration, Hazard Ratio (HR), and its 95%CI were used to estimate the risk factor of ILD. Result: Our result showed that ILD patients in severe and progressive groups had higher KL-6 levels, and the KL-6 level of patients in the severe ILD was 703.41 (U/ml) than in mild ILD. The KL-6 level in progressive ILD group was 325.98 (U/ml) higher than that in the non-progressive ILD group. Secondly, the KL-6 level of patients in acute exacerbation (AE) of ILD was 545.44 (U/ml) higher than stable ILD. Lastly, the higher KL-6 level in ILD patients predicted poor outcomes. The KL-6 level in death of ILD was 383.53 (U/ml) higher than in survivors of ILD. The pooled HR (95%CI) about elevated KL-6 level predicting the mortality of ILD was 2.05 (1.50–2.78), and the HR (95%CI) for progression of ILD was 1.98 (1.07–3.67). Conclusion: The elevated KL-6 level indicated more severe, more progressive, and predicted the higher mortality and poor outcomes of ILD. [ABSTRACT FROM AUTHOR]