Wednesday, 27 November 2013

Lower respiratory tract infection - Pneumonia – The Complications

Lower respiratory tract infection
The lower respiratory tract infection are the infection consisting of the trachea (wind pipe), bronchial tubes, the bronchioles, and the lungs, including the bronchitis and pneumonia. According to  The World Health Report 2004 – Changing History(1), in 2002 lower respiratory track infection were still the leading cause of deaths among all infectious diseases, and accounted for 3.9 million deaths worldwide and 6.9% of all deaths that year.
Pneumonia is defined as a condition of the inflammation of the lung as a result of infection, caused by bacteria, such as bacteria Streptococcus pneumoniae or influenza viruses in most cases. Fungi, such as Pneumocystis jiroveci, certain medication such as PPI Stomach Acid Drugs and other conditions such as impaired immune systems.
A.3. Complications
1. Cardiac complications
In the study of a total of 1343 inpatients and 944 outpatients with community-acquired pneumonia followed up prospectively for 30 days after presentation, showed that incident cardiac complications are common in patients with community-acquired pneumonia and are associated with increased short-term mortality. Older age, nursing home residence, preexisting cardiovascular disease, and pneumonia severity are associated with their occurrence. Further studies are required to test risk stratification and prevention and treatment strategies for cardiac complications in this population(45).
2. Mortality
Community-acquired pneumonia is the most common infectious cause of death in the US. In the study of a  total of 2,654,955 cases of pneumonia from 1987-2005, found that during this period, the proportion treated as inpatients decreased, the proportion aged ≥80 years increased, and the frequency of many comorbidities rose. Adjusted incidence increased to 3096 episodes per 100,000 population in 1999, with some decrease thereafter. Age/sex-adjusted mortality decreased from 13.5% to 9.7%, a relative reduction of 28.1%. Compared with 1987, the risk of mortality decreased through 2005 (adjusted odds ratio, 0.46; 95% confidence interval, 0.44-0.47). This result was robust to a restriction on comorbid diagnoses assessing for the results’ sensitivity to increased coding(46).
3. Pleurisy 
Pleurisy is defined as condition of the inflammation of the lining of the pleural cavity surrounding the lungs.There is a report of a 40-year-old female was admitted with right chest pain. SLE was absent from her past history, although she complained of polyarthralgia in winter. Atypical pneumonia/pleuritis was suspected by chest X-ray film, showing a nodular shadow in the right lower field and moderate pleural effusion. Chlamydia pneumonia was diagnosed by elevated anti-C. psittsci antibody, while characteristics of pleural fluid revealed serositis accompanied by SLE because of the high titered anti-DNA antibody and the low titered complement(47).
4. Lung diseases
Acute-onset diffuse interstitial lung disease (AoDILD) in patients with rheumatoid arthritis (RA) has been a serious concern, especially for those under treatment with biological agents which may affect the presentation and outcome of AoDILD, including Pneumocystis pneumonia (PCP)(48).
5. Bacteremia
In the study to determine whether serotype 1 (SP1) invasive pneumococcal disease (IPD) can be distinguished by demographic, clinical and laboratory characteristics from IPD caused by the other most common serotypes (MCS) in the region: 5, 14, 6A, 6B, 19A, 19F, 23F of the study, found that
SP1 was found less frequently than MCS in children with underlying diseases, but was more frequent in older and Bedouin children with IPD. SP1was more frequently associated with bacteremic pneumonia and primary peritonitis than MCS grouped(49).
6. Endocarditis
There is a report of a case of mitral endocarditis caused by Streptococcus pneumoniae in a 43 year old man with history of alcohol abuse and cigarette smoking. The pneumococcal endocarditis was associated with pneumonia, meningitis and brain abscess. Only transesophageal echocardiography could confirm the presence of vegetation(50).
7. Respiratory acidosis
Respiratory acidosis is defined as a condition of which the lungs nolonger cannot remove all of the carbon dioxide produced by the body.
Ventilator-associated pneumonia (VAP) is a common complication of ventilatory support for patients with acute respiratory failure and is associated with increased morbidity and mortality, according to the study by Jawaharlal Nehru Medical College(51).
8. Hypoxemic Respiratory Failure
There is a report a case of severe pneumonia complicated by acute hypoxemic respiratory failure due to primary infection with C. pneumoniae in a previously healthy 46-year-old woman(52).
9. Etc.

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