Study: Benzodiazepines And Community Acquired Pneumonia

Photo Credit CDC 

 

Note: I’ll be on the road today and tomorrow, and may not be able to update this blog until Sunday.

In the meantime, I invite you to check in with Crofsblog for the latest news, Maryn McKenna for the latest on antibiotic resistance (and other topics), and to explore FluTrackers. 

 

 

# 6768

 

A study that appeared this week in the BMJ respiratory disease journal Thorax finds that `Benzodiazepines were associated with an increased risk of, and mortality from CAP’ (Community Acquired Pneumonia).

 

Benzodiazepines are a commonly prescribed class of  anti-anxiety, sedative, and anti-convulsive medications that include such stalwarts as Valium, Paxal, and Halcion (among many others). 

 

Their sedative effects can (particularly when combined with alcohol) depress the respiratory system, and act as a cough suppressant – both of which could conceivably contribute to an increased incidence of pneumonia.

 

The study – which looked at nearly 5,000 pneumonia cases and more than 29,500 controls - found a 54% increase in pneumonia among patients taking benzodiazepines (although not with chlordiazepoxide (Librium)) and a 22% increased mortality rate.

 

A link to the study, and excerpts from the abstract follow:

 

The impact of benzodiazepines on occurrence of pneumonia and mortality from pneumonia: a nested case-control and survival analysis in a population-based cohort

Eneanya Obiora, Richard Hubbard, Robert D Sanders, Puja R Myles

Abstract

Objectives Benzodiazepines have been associated with an increased incidence of infections, and mortality from sepsis, in the critically ill. Here, we determined the effect of community use of benzodiazepines on the occurrence of, and mortality following, pneumonia.

<SNIP Methods & Results>

Conclusions Benzodiazepines were associated with an increased risk of, and mortality from, CAP. These hypothesis generating data suggest further research is required into the immune safety profile of benzodiazepines.

 

 

It is worth noting that an earlier study (J Am Geriatr Soc. 2011 Oct) found quite the opposite; that opioids, but not benzodiazepines, were associated with increased incidences of pneumonia.

 

Use of opioids or benzodiazepines and risk of pneumonia in older adults: a population-based case-control study.

Dublin S, Walker RL, Jackson ML, Nelson JC, Weiss NS, Von Korff M, Jackson LA.

Source

Group Health Research Institute, Seattle, Washington 98101, USA. dublin.s@ghc.org

Abstract

OBJECTIVES:

To examine whether use of opioids or benzodiazepines is associated with risk of community-acquired pneumonia in older adults.

CONCLUSION:

Use of opioids but not benzodiazepines was associated with pneumonia risk. The differences in risk seen for different opioid regimens warrant further study.

 

 

Dueling studies are nothing new. Different methodologies, and different patient demographics, can produce strikingly different results.

 

The second study - which found no link between benzodiazepines and pneumonia - looked only at older patients (aged 65 to 94), and was based on a much smaller number of pneumonia cases and controls.

 

So while similar in intent, comparing these studies is not quite like comparing apples to apples.

 

Although not a slam dunk, there is enough evidence here that the authors of this week’s study urge:

 

These hypothesis generating data suggest further research is required into the immune safety profile of benzodiazepines.

»» Read More

Hong Kong: Investigating An Unidentified Respiratory Illness Outbreak

 

Photo Credit USDA

 

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From Hong Kong’s Centre for Health Protection today a report on five workers at an agricultural station who have contracted an – as yet unidentified – respiratory illness.

 

These patients have tested negative for the `usual suspects’, including influenza, RSV, and Legionnaire’s Disease. They all work at an animal management center that recently took in 16 seized parrots, 3 of which subsequently died.  

 

Testing is now underway for Psittacosis (parrot fever).  First the report, then I’ll return with a few brief notes.

 

 

Joint investigation into suspected outbreak of respiratory disease in Sheung Shui

The Centre for Health Protection (CHP) of the Department of Health is today (November 26) conducting a joint investigation with the Agriculture, Fisheries and Conservation Department (AFCD) into a suspected outbreak of respiratory disease involving five AFCD staff working in the New Territories North Animal Management Centre (NTNAMC) in Sheung Shui. They were all males aged between 27 and 64 with onset of symptoms from November 6 to November 24.

The first case affected a 64-year-old man who presented with upper respiratory symptoms since November 6. He was admitted to a hospital in Australia since November 12.

 

The second case is a 55-year-old man. He developed chills, cough and sore throat since November 8 and fever, shortness of breath, headache and myalgia since November 19. He was admitted to Queen Mary Hospital (QMH) on November 22. His chest X-ray showed bilateral upper zone patchiness and the clinical diagnosis was pneumonia. He is now receiving care in the Intensive Care Unit of QMH in stable condition.

 

Respiratory and urine specimens taken from the 55-year-old patient at QMH tested by the hospital yielded negative results for influenza virus, respiratory syncytial virus (RSV) and Legionnaires' Disease, while test results for psittacosis and leptospirosis are pending. CHP's Public Health Laboratory Centre performed tests on the patient's respiratory specimens and it was negative for Novel Coronavirus associated with Severe Respiratory Disease.

 

The third case affected a 62-year-old man who developed bilateral red eyes on November 12, and was admitted to Alice Ho Miu Ling Nethersole Hospital on November 17 because of cough with blood-stained sputum, malaise, chills, rigors and sore throat. His condition was stable. The diagnosis was pneumonia. Preliminary laboratory testing for influenza virus, parainfluenza virus, RSV and adenovirus was negative.

 

The fourth case is a 27-year-old man. He developed fever, headache and malaise on November 14 and was admitted to Yan Chai Hospital on November 18. The diagnosis was pneumonia. He recovered after treatment and was discharged home on November 22 and his condition was stable.

 

The fifth case affected a 62-year old man who presented with cough, chills and rigor since November 24 and was admitted to Princess Margaret Hospital for further management on November 26. His condition is stable.

 

The home contacts of the patients are asymptomatic.

 

CHP staff conducted a site visit to NTNAMC today and provided health advice to the staff.

 

According to the information provided by AFCD, there is a batch of 16 seized parrots being kept in NTNAMC since October 20. Subsequently, three died and 10 were euthanised as precautionary measures. The health condition of the three surviving birds is being closely monitored.

 

The possibility of psittacosis outbreak among these staff is being actively investigated.

 

 

While we don’t yet know if Psittacosis is behind this outbreak, parrot fever continues to cause small outbreaks around the world. It is caused by Chlamydia psittaci, one of several microorganisms in the genus Chlamydia that is shed in the feces of many birds.

 

In 2007 (see To You, My Heart Cries Out Chlamydia) I wrote about a small outbreak that occurred at a Bird lovers Society show in Weurt, Norway.

 

And earlier this year I told the fascinating story of how parrot fever was responsible for the creation of the NIH in the United States (see How Parrot Fever Changed Public Health In America).

 

The CDC maintains a Psittacosis website, with the following information.

 

Clinical Features
In humans, fever, chills, headache, muscle aches, and a dry cough. Pneumonia is often evident on chest x-ray.

Etiologic Agent
Chlamydia psittaci, a bacterium

Incidence
Since 1996, fewer than 50 confirmed cases were reported in the United States each year. Many more cases may occur that are not correctly diagnosed or reported.

Sequelae
Endocarditis, hepatitis, and neurologic complications may occasionally occur. Severe pneumonia requiring intensive-care support may also occur. Fatal cases have been reported.

Transmission
Infection is acquired by inhaling dried secretions from infected birds. The incubation period is 5 to 19 days. Although all birds are susceptible, pet birds (parrots, parakeets, macaws, and cockatiels) and poultry (turkeys and ducks) are most frequently involved in transmission to humans.

Risk Groups
Bird owners, pet shop employees, and veterinarians. Outbreaks of psittacosis in poultry processing plants have been reported.

Surveillance
Psittacosis is a reportable condition in most states.

Trends
Annual incidence varies considerably because of periodic outbreaks. A decline in reported cases since 1988 may be the result of improved diagnostic tests that distinguish C.psittaci from more common C. pneumoniae infections.

Challenges
Diagnosis of psittacosis can be difficult. Antibiotic treatment may prevent an antibody response, thus limiting diagnosis by serologic methods. Infected birds are often asymptomatic. Tracebacks of infected birds to distributors and breeders often is not possible because of limited regulation of the pet bird industry.

Opportunities
Characterize new and rapid diagnostic tests for human and avian psittacosis, and determine value of screening flocks for avian psittacosis to prevent human infection.

 

»» Read More

Preventing Pneumonia in Children

DO NOT underestimate pneumonia. According to UNICEF, pneumonia being one of the diseases that threaten children. There are approximately 155 million cases of child pneumonia every year in the world.

Pneumonia is a form of acute respiratory infection that affects the lungs. The infection is caused by alveoli do not work optimally when filling the air in the lungs, which then will cause difficulty breathing because the oxygen intake is limited.

In many studies suggest that pneumonia in children is caused by two types of bacteria, namely: Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae. Both of these bacteria can also cause acute meningitis (infection of the membranes covering the brain) in children.

In timesofindia.com site mentions, in addition to difficulty in breathing, whooping cough is a common symptom in children when he was stricken with pneumonia. Pneumonia can be treated effectively with antibiotics. But in the case of pneumonia that further treatment can be carried out through the method of X-rays. Pneumonia can be prevented in several ways, such as:

1. Exclusive breastfeeding during the first six months
This is an important step to ensure that your baby is getting enough nutrition and build a natural immunity to bacteria and viruses
2. Giving vaccines recommended by the doctor in the first year of birth
3. Keeping the environment clean
4. Get children to live healthy snack at random and do not wash their hands before eating.

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Recognize Early as Possible Symptoms of Pneumonia In Infants

Recognizing the signs that our baby is being exposed to infectious pneumonia is straightforward. Even as easy as we reverse the hands.
Some toddlers are at risk of contracting an infection is pneumonia. Pneumonia is very attacking in children suffering from malnutrition, no / less breastfed, have birth defects, exposure to air pollution, and exposure to cigarette smoke.
It was submitted by Dr Lindia Setiyawati, Sp.A. (K), lung specialists, when speaking in the seminar participants' Danger Infectious Diseases in Children "held at Scholastic Expo, some time ago.
One way to know the signs of pneumonia infection in children is to calculate the speed of the breath on the baby. If your child aged less than 2 months but took a breather more than 60 times in 1 minute, and there is pull into the bottom of the chest wall, each time to breathe, it is advisable to immediately bring to the doctor to be medically examined. Because your baby is feared contracting pneumonia infection.
It is better to prevent than to treat, so the saying goes. Lots can be done to prevent toddlers are not easily affected by pneumonia. For example, by recognizing the signs of pneumonia which is basically very easy to know. It could also make improvements in infant nutrition, keeping the environment clean, and do not forget immunizations.
Many people think "if it is easily preventable and treatable so why worry?". Make no mistake, according to a survey pneumonia kills one baby every four minutes in all parts of the world. Well, recognize the sign and prevent. Since prevention is better than cure.

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Prevent Toddlers from Pneumonia

Air pollution is harmful to health. For children, exposure to air pollution is one of the risk factors for pneumonia or inflammation of the lung tissue. The cause is a bacterial infection. When the infected lung, the organ can not perform its function, which is to get oxygen to the body.

Every year, pneumonia kills about 1.8 million children under the age of five years, or about 20 percent of all deaths of children under five in the world. Indonesia, according to UNICEF and WHO report in 2006, was ranked sixth in the world. According to a survey in 10 provinces conducted by ARI Sub Health Ministry in the Basic Health Research 2007, 15.5 percent of the causes of death of children under five is pneumonia.


According to Dr. Darmawan BS, SpA (K), Chairman of Respirology Indonesian Pediatric Association, in addition to exposure to pollution, pneumonia can strike babies born with low weight or premature, not given breast milk (ASI) exclusively, not immunized with complete, vitamin A deficiency, and malnourished.

Darmawan explains, the early stages of pneumonia symptoms are usually preceded by symptoms of influenza (fever, cough, and runny nose), and accompanied by headache and loss of appetite.

Pneumonia stage characterized by rapid breathing, nasal flaring, to difficulty breathing. "In the late stage, characterized by breathing with the pull of the chest wall," he said.

Meanwhile, in severe cases, is characterized by a drop in body temperature, seizures, loss of consciousness, can not eat, until the child's skin looks blue.

Dr I Boediman, SpA (K), Division of Respirology staff Cipto Mangunkusumo Hospital, Jakarta, adding, if it finds a child with symptoms of difficulty breathing, fever, and eating disorders, immediately take the child to the hospital. For children who have difficulty breathing and lack of oxygen, he needs to be treated with the help of oxygen.

In addition, the necessary nutrition to improve the immune system of children. "Especially vitamin A and zinc (zinc)," said Boediman. Good nutrition is useful to prevent an attack of pneumonia or speed healing.

Preventive measures should also be done through immunization. DPT and measles immunization provides immunity against diseases that increase a child's risk of pneumonia. While Hib and pneumococcal immunization provides immunity against the penetration of germs that cause pneumonia.

Environmental factors must also be considered. "Children should be kept away from exposure to cigarette smoke, kitchen smoke, and air pollution," said Boediman. The house should be well ventilated, kept clean, and do not cough or sneeze haphazardly. Because the transmission of pneumonia vulnerable through coughing or sneezing spark. Should cover mouth when coughing or sneezing, wash your hands after coughing / sneezing, and using protective masks.

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Tips to Prevent Pneumonia

Inflammatory disease of the lungs or pneumonia is difficult to be cured, but it certainly prevented before it happens is better than cure, and will have fatal consequences for patients suffering from chronic diseases such as kidney failure or heart disease, and the disease will be difficult in avoid if one grows older.

To forbid this disease before it got infected. but like where is his way of preventing pneumococcal disease or pneumonia? .

To prevent pneumonia or pneumococcal disease can be done following these tips include:

• Keep the bad habits that can damage lung health
• Do not consume foods and beverages that contain alcohol while in tow
• Not being active smokers and try to keep myself to be passive peroko
• Always exercise routine to keep the body healthy and fit
• multiply the drinking water for the body to always replace fluids that have become toxic
• Multiply to consume foods that contain high antioxidants like fruits and vegetables.
• Reduce the habit of drinking coffee, because coffee contains caffeine high enough
• Always use disposable tysu while being exposed to colds.
• Cleaning up the environment and planting trees so that our lungs can always breathe fresh daily udar
• Similarly, a glimpse of an explanation of how tips to prevent your body from being infected pneumonia or pneumococcal disease, hopefully this article can be helpful and useful to those who read them, and may we always give health to always be running the day-to-day activities we are well of course.

For those of you who are already infected with pneumonia or by any other name is an inflammatory disease of the lungs do not worry, because now present a new finding Lung Inflammatory Herbs

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How To Prevent Pneumonia In Children

A Works Progress Administration poster describes pneumonia as a large man-eating shark led by pilot fish, the common cold. This is a very apt description as pneumonia can assume proportions monster shark, sometimes much more frightening. And also the fact that in the majority of cases of the common cold is the most likely cause. This terrible disease was first described by Hippocrates called pneumonia disease "named by the ancients". Pneumonia is the leading cause of death in low-income countries and, according to the World Health Organization, pneumonia caused the death of three newborns. Effective treatment is hampered by the fact that there is relatively low awareness of the disease. So, in many cases when people seek medical help, the disease will take root. To address this lack of awareness, 2 November has been declared as World Pneumonia Day so that policy makers and the concerned person can formulate a strategy against this disease. The disease is very common among children and so it is very important that parents and guardians familiarize themselves with pneumonia. This not only makes them more aware of the disease but will also help them in taking steps to prevent pneumonia in children. To find out how you can prevent pneumonia in children read below.

How To Prevent Pneumonia In Children

1.  Teach your children good hygiene. Make sure they wash their hands before eating and after using the toilet. Children also have to learn to wash their hands after sneezing and handle all other unhygienic.
2. Do not smoke near children. Also, keep your kids from people who smoke. Tobacco smoke reduces lung's ability to ward off infections. It can also damage the body's natural defense system and also increases the risk of infection by pneumonia.

»» Read More

How to Prevent Pneumonia

  Pneumonia is a bacterial or viral respiratory infection characterized by inflammation of the lungs. Do not be underestimated because the disease can be life-threatening, especially to young children, the elderly and those with chronic health problems.

However, there are some ways to help prevent an attack of pneumonia, among others:

     * Frequently wash your hands, especially after using the toilet, changing diapers, preparing or eating food, or remove mucus and debris from the nose.
     * Do not smoke.
     * Get vaccinated for pneumonia and flu.
     * Children should get Hib vaccine.
     * In some children younger than 24 months, the drug palivizumab can be prescribed to help prevent pneumonia as a complication of other respiratory problems.

»» Read More

Causes of Pneumonia

Pneumonia can be caused by microorganisms, irritants and unknown causes. When pneumonia grouped in this way, causing an infection is the most common type.

Symptoms of infectious pneumonia caused by the invasion of the lungs by microorganisms and the immune system's response to infection. Although more than one hundred types of microorganism can cause pneumonia, only a few are responsible for most cases. The most common causes of pneumonia are viruses and bacteria. Less common causes of infectious pneumonia are fungi and parasites.

Virus
The virus attacks the cells to reproduce. Typically, a virus reaches the lungs when airborne droplets are inhaled through the mouth and nose. Once in the lungs, the virus invades the cells lining the airways and alveoli. This invasion often leads to cell death, either when the virus directly kills the cells, or by the type of cell apoptosis controlled self-destruction called. When the immune system responds to viral infections, lung damage even more the case. White blood cells, particularly lymphocytes, activate certain chemical cytokines which allow fluid to leak into the alveoli. The combination of cell destruction and fluid-filled alveoli disrupt normal transportation of oxygen into the bloodstream.

As well as damaging the lungs, many viruses affect other organs and thus disrupt many body functions. Viruses can also make the body more susceptible to bacterial infections, bacterial pneumonia reason that often complicate pneumonia.

Viral pneumonia is commonly caused by viruses such as influenza virus, respiratory syncytial virus (RSV), adenovirus, and metapneumovirus. Herpes simplex virus is a rare cause of pneumonia except in newborns. People with weakened immune systems are also at risk of pneumonia caused by cytomegalovirus (CMV).

Bacterium
Bacteria typically enter the lung when airborne droplets are inhaled, but can also reach the lung through the bloodstream when there is an infection in another part of the body. Many bacteria live in the upper respiratory tract, including the nose, mouth and sinuses, and can easily be inhaled into the alveoli. Once inside, the bacteria can invade the space between cells and between alveoli through connecting pores. This invasion triggers the immune system to send neutrophils, a type of defensive white blood cells, to the lungs. Neutrophils engulf and kill the offending organisms, and also release cytokines, causing a general activation of the immune system. It causes fever, chills, and fatigue common in bacterial and fungal pneumonia. Neutrophils, bacteria, and fluid from surrounding blood vessels fill the alveoli and interrupt normal oxygen transportation.

Bacteria often travel from infected lungs into the bloodstream, causing serious or even fatal illness such as septic shock, with low blood pressure and damage to some parts of the body including the brain, kidneys, and heart. Bacteria can also travel to the area between the lungs and the chest wall (the pleural cavity) causing a complication called empyema.

The most common causes of bacterial pneumonia are Streptococcus pneumoniae'''' and "atypical" bacteria. Atypical bacteria are intracellular parasitic bacteria that live or do not have a cell wall. In addition, they cause generally less severe pneumonia, thus atypical symptoms, and respond to different antibiotics than other bacteria.

Types of Gram-positive bacteria that cause pneumonia can be found in the nose or mouth of many healthy people. Streptococcus pneumoniae'''', often called "pneumococcus", is the most common bacterial cause of pneumonia in all age groups except newborns. Pneumococcus kills approximately one million children each year, mainly in developing countries. Other causes important Gram-positive Staphylococcus aureus pneumonia is'''','''' Streptococcus agalactiae to be an important cause of pneumonia in newborns. Gram-negative bacteria cause pneumonia less frequently than gram-positive bacteria. Some gram-negative bacteria that cause pneumonia include Haemophilus influenzae'''','''' Klebsiella pneumoniae, Escherichia coli'''','' Pseudomonas aeruginosa'' and'' Moraxella catarrhalis''. These bacteria often live in the stomach or intestines and can enter the lungs if inhaled vomit. "Atypical" bacteria which cause pneumonia include Chlamydophila pneumoniae'''','''' Mycoplasma pneumoniae, and Legionella pneumophila''''.

Mushrooms
Fungal pneumonia is rare, but can occur in individuals with immune system problems due to AIDS, immunosuppresive drugs, or other medical problems. Pathophysiology of pneumonia caused by fungi is similar to bacterial pneumonia. Fungal pneumonia is most often caused by Histoplasma capsulatum'''', blastomyces,'' Cryptococcus neoformans'','' Pneumocystis jiroveci'', and'''' Coccidioides immitis. Histoplasmosis is most common in the Mississippi River basin, and coccidioidomycosis in the southwestern United States.

Parasite
A variety of parasites can affect the lungs. These parasites typically enter the body through the skin or swallowed. Once inside, they travel to the lungs, usually through the blood. There, as in other cases of pneumonia, a combination of cellular destruction and immune response causes disruption of oxygen transportation. One type of white blood cell, eosinophil, it responds vigorously to parasite infection. Eosinophils in the lungs can lead to eosinophilic pneumonia, making it difficult for the underlying parasitic pneumonia. The most common parasites causing pneumonia'' Toxoplasma gondii'','' Strongyloides stercoralis'', and'''' ascariasis.

Idiopathic
Idiopathic interstitial pneumonia (IIP) is a class of diffuse lung disease. In some types of IIP, eg some types of usual interstitial pneumonia, the cause, indeed, is unknown or idiopathic. In some types of IIP known to cause pneumonia, interstitial pneumonia Desquamative instance caused by smoking, and the name is a misnomer.

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Wary Pneumonia in Children

Pneumonia is actually not a new disease. Pneumonia in 1936 became the number one cause of death in America. The use of antibiotics, making the disease can be controlled a few years later. But in 2000, a combination of pneumonia and influenza reignited.

In Indonesia, pneumonia is the number three cause of death after cardiovascular and tuberculosis. Socioeconomic factors that enhance the low mortality rate. Pneumonia cases found to be most common in children under five. According to the WHO, about 800,000 to 1 million children die each year from pneumonia. Even UNICEF and the World Health Organization has pneumonia as the cause of death of children under five highest, surpassing other diseases such as measles, malaria, and AIDS.

Pneumonia is an infection that causes inflammation of the lungs. Air sacs in the lungs called alveoli filled with pus and fluid that becomes less ability to absorb oxygen. Lack of oxygen makes the body's cells can not work. Because of this, in addition to the spread of infection throughout the body, the patient can die of pneumonia. Actually pneumonia is not a single disease. The causes can vary, and there are 30 known sources of infection with the primary source of bacteria, viruses, mikroplasma, mushrooms, various chemicals and particles.

Pneumonia is an acute infection of the tissues of the lungs (alveoli). The occurrence of pneumonia in children often goes together with the acute infection of the bronchi (called bronchopneumonia). Symptoms of this disease such as rapid breathing and shortness of breath, because suddenly inflamed lung. Limit the frequency of fast breathing is breathing 50 times per minute or more in children aged 2 months to less than 1 year, and 40 times per minute or more in children aged 1 year to less than 5 years. In children under the age of 2 months, no known diagnosis of pneumonia.

Severe pneumonia characterized by cough or (accompanied) difficulty breathing, shortness of breath or chest wall drawing down to the children aged 2 months to less than 5 years. In this age group is also known for very severe pneumonia with symptoms of cough, difficulty breathing accompanied by symptoms of central cyanosis and can not drink. As for children under 2 months, severe pneumonia characterized by respiratory frequency of 60 times per minute or more, or (accompanied) strong withdrawal to the chest wall into the bottom.

According to specialists lungs RSIA Hermina Jatinegara, Dr. Bambang Supriyatno SpA (K), the fundamental difference between pneumonia with TB lies in the type of infecting microorganisms. '' Pneumonia in the community generally, caused by bacteria, viruses or mycoplasma (an intermediate form between bacteria and viruses),'' he said. Bambang said the bacterium Streptococcus pneumoniae is a common, Staphylococcus aureus, Klebsiella sp, Pseudomonas sp. Meanwhile, viruses such as influenza virus. "At TBC, type of infecting microorganism is mikrobakterium tuberculosis,'' he continued. The vulnerability of children affected by the disease pneumonia generally due to a weak or incomplete immune system toddler. Therefore, microorganisms or germs more easily penetrate the body's defenses.

Types of pneumococcus bacteria or pneumokok increasingly popular recently as more dikenalnya disease Invasive Pneumococcal Disease (IPD). In addition to pneumonia, including the IPD brain (meningitis) or blood infection (bacteremia). "In the pneumonia caused by bacteria pneumokok, often cause complications and result in patients affected by meningitis or bacteremia as well," he said.

A pediatrician from RSAB Harapan Kita, Dr. Attila Dewanti pneumokok SpA explained that bacteria can enter through infection in the mouth and throat, through the mucosal tissue and into the blood vessel, the blood flow to the lungs and lining of the brain. "The result is inflammation of the lining of the lungs and the brain," he added.

Symptoms especially fever, shortness of breath, rapid breathing and pulse, or greenish phlegm like rubber, and the results of X-ray showed the density in the lung. Density is because lungs filled with inflammatory cells and fluid that is a reaction of the body to kill germs. But consequently, impaired lung function, patients have difficulty breathing, because it left no room for oxygen.

However, the initial symptoms are often quite simple to make parents less vigilant against the disease. "Parents often come too late to bring her son to the doctor. Because the initial symptoms of fever and cough, parents often treat their own home with regular medication, have been crowded recently taken to the doctor, "said Atilla. So the doctor spesialins child neurology section should declare this when children high fever and cough, get to the doctor to search out the cause.

Diagnosis and Treatment

The diagnosis of pneumonia is done in various ways. First a general physical examination. After that there are penunjuang such as chest X-ray examination and blood tests. Handling pneumonia can be done in several ways. Generally, the treatment with antibiotics. "People with pneumonia can be cured when given antibiotics according to the type of bacteria, only need high doses and long-time," said Atilla.

However, the bacteria Streptococcus pneumoniae from resistant or immune to some types of antibiotics. Even the Asia expressed as a hot zone, ie, areas with high levels of resistance to bacterial pneumokok. Therefore, when faced severe pneumonia, the handling is also done by hospitalization. With special care in the hospital, patients can get more rest and intensive treatment, or even oxygen therapy as a supporter. In addition, people with pneumonia also need plenty of fluids to prevent dehydration. This fluid can be obtained by drinking lots of water and through an IV.

For pneumonia by the virus is currently no specific guidelines, although some antiviral drugs have been used. Most patients can be treated at home. Usually doctors who deal with pneumonia will have the appropriate medications, respectively, after the patient's temperature returned to normal, the doctor will instruct advanced treatment to prevent recurrence. Its next attack could be more severe than the first. In addition to antibiotics, patients will also receive additional treatment in the form of the pattern of food and oxygen to increase the amount of oxygen in the blood.

In some cases, Atilla explained that pneumonia is experiencing complications that can leave many side effects. "Children can have many side effects such as interference intelligence, motor development, hearing loss and speech delay," he said. However, Bambang still ensure that children with pneumonia can also be cured and live normally.

Prevention

Pneumonia disease control the focus of the program P2ISPA (Communicable Disease Acute Respiratory Infection). The program sought to terms pneumonia known to the public, to facilitate outreach activities and dissemination of information about handling. P2ISPA program classifies patients into 2 age groups. That is, under the age of 2 months (Pneumonia and Non-Pneumonia weight) and the age of 2 months to less than 5 years.

Classification of Non-pneumonia include cough five groups of people who did not show an increase in the frequency of respiratory symptoms and do not indicate a withdrawal of the chest wall into the bottom. ISPA disease outside of pneumonia include common colds, pharyngitis, tonsillitis and otitis. Classic phrase that "prevention is better than cure" is really relevant to the disease pneumonia. Given that treatment more difficult, mainly related to the increasing resistance of bacterial pneumonia, the prevention measures are recommended.

IPD prevention of diseases, including pneumonia, can be done by vaccination or pneumococcal vaccine is also known as IPD. According to Atilla who also served in a special clinic children RSAB our expectations, the opportunity to prevent pneumonia vaccine IPD is around 80-90%.

As for the ideal time IPD vaccine, according to Atilla explanation is 4 times, namely when the baby was 2 months, 4 months, 6 months and repeated again at 12 months of age. Atilla confirm that the vaccine is safe and can be given simultaneously with other vaccines such as Hib, MMR and Hepatitis B.

In addition to immunization, prevention of pneumonia, according to Bambang is to maintain a balance of child nutrition. "In addition, an effort so that children have a good immune system, among others, by the way also sporting enough rest," he explained.

Bacterial Pneumonia by

Triggered bacterial pneumonia can attack anyone, from infancy to old age. Actual cause of bacterial pneumonia is the most common is Streptococcus pneumoniae in healthy human esophagus. Once the body's defenses down by sickness, old age, or malnutrition, the bacteria multiply quickly and cause damage. Whole lung tissue filled with fluid and infection quickly spread throughout the body via the bloodstream.

Patients infected with pneumonia will be high fever, sweating, panting, and his heart rate increased rapidly. Lips and nails may turn blue due to lack of oxygen the body. In the case of eksterm, patients will be chills, teeth bergemelutuk, chest pain, and coughing when the green slime. Before too late, the disease is still treatable. Even for preventive vaccine has been available.

Pneumonia by virus

Half of the estimated incidence of pneumonia caused by a virus. Nowadays more and more viruses were identified. Although most of these viruses attack the upper respiratory tract, especially in children, this interference can lead to pneumonia. Fortunately, most types of pneumonia is not severe and recovered in a short time.

However, when infection occurred simultaneously with the influenza virus, interference can cause serious and sometimes death, virus that infects the lungs will breed even though no visible fluid-filled lung tissue. Symptoms of pneumonia by the same with influenza virus, include fever, dry cough headache, pain throughout the body. And weary, for 12-136 hours, breathing becomes congested, cough more severe and result in a number of mucus. High fever sometimes make lips turn blue.

Mycoplasma Pneumonia

These different types of pneumonia symptoms and physical signs of pneumonia when compared with the general. Therefore, suspected pneumonia caused by a virus that is not found often called pneumonia that is not typical (Atypical Penumonia). Mycoplasma can not be classified as viruses or bacteria, although it has characteristics of both. Pneumonia resulting degree is usually mild and widespread. Mycoplasma attack all types of ages. But most often in young men and young adolescents. The death rate is very low, even in the untreated.

The most common symptoms are severe coughing, but with a little mucus. Fever and chills only appear at the beginning, and in some patients could be nausea and vomiting. New weakness disappeared for a long time.

Other Types of Pneumonia

Included in this group are Pneumocystitis pnumonia carinii (PCP) which is thought to be caused by fungi, PCP usually be early signs of disease in people with HIV / AIDS. PCP can be treated in most cases. This disease could reappear a few months later, but the treatment will prevent or menundah recurrence. Another more rare pneumonia caused by the entry of food, liquids, gases, dust or mold. Rickettsia-entry group also between viruses and bacteria-causing Rocky Mountain fever, Q fever, typhoid, and psittacosis. These diseases also interfere with the function of the lungs, but TB eyebrows tuberculosis pneumonia is a lung infection most dangerous unless dioabati early.

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natural way treat pneumonia

Pneumonia or medical term pneumonia is an infection of one or two of the lungs that is usually caused by bacteria, viruses or fungi. Currently, more than 3 million people are infected with pneumonia. More than half a million people treated in hospital for hospitalization.  its 5% will die from pneumonia, and the disease is still the leader of the six causes of death in America.

How do people "get pneumonia? '

Some cases of pneumonia acquired by inhaling mists small (droplets) containing organisms that can cause pneumonia. Drizzle it into the air when a person infected with these germs coughs or sneezes. In other cases, pneumonia is caused when bacteria or viruses that are normally present in the mouth, throat, or nose inadvertently enter the lung. During sleep, it is entirely common for people to suck secretions (expenses) from the mouth, throat, or nose. Normally, the body's reflex response (coughing out secretions) and immune system will prevent organisms sucked cause pneumonia. However, if someone is in a weakened condition from another illness, a severe pneumonia can develop. People with viral infections recently, lung disease, heart disease, and swallowing problems, as well as users of drugs and alcohol, and those who have suffered a stroke or epilepsy are at high risk of developing pneumonia than the general population.

Once organisms enter the lungs, they usually settle in the air sacs of the lung where they rapidly grow in number. Area of ​​the lung then becomes filled with fluid and pus as the body attempts to fight off infections.

Symptoms And Signs of Pneumonia

Most people who are infected with pneumonia initially have symptoms of a infuensa which is then followed by a high fever (sometimes as high as 104 degrees Fahrenheit), chills, and a cough with production of sputum (phlegm). Sputum is usually discolored and sometimes bloody. People with pneumonia may become short breath. The only pain fibers in the lung is the lung surface, in the area known as the pleura. Chest pain may develop if the pleural aspects of the outside of the lung involved. This pain is usually sharp and worsens when taking a deep breath, known as pleuritic pain.

In other cases of pneumonia, may occur a slow onset of symptoms. A worsening cough, headaches, and muscle aches may be the only one of the symptoms. In some people with pneumonia, coughing is not a major symptom because the infection is located in areas of the lung away from the airways is greater. At times, an individual's skin color may change and become dusky or purplish (a condition known as "cyanosis") due to their blood dioksigenasi poorly.

Children and babies who contracted pneumonia often do not have any specific signs anywhere from a chest infection, but hit a fever, appear quite ill, and may become lethargic. Those older people may also have few symptoms with pneumonia.

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Symptoms of Pneumonia-natural cure for pneumonia

Symptoms of  Pneumonia is a lung infection caused by bacteria, fungi and viruses, the early symptoms of this disease are cough, fever, and difficulty breathing. Pneumonia can occur in daily life at home, school or workplace.

Pneumonia occurs because bacteria and viruses adaanya inhaled and enter the lungs. Most likely contract the disease if you are exposed to a cold or flu. Flu and colds this makes it difficult for the lungs to fight infection, making it more susceptible to pneumonia. Having a long-term illness, or chronic, such as asthma, heart disease, cancer or diabetes will be easier for pneumonia.

Symptoms of Pneumonia

Symptoms of pneumonia caused by bacteria usually come quickly. Symptoms are as follows:


Cough. Cough mucus (phlegm), thick or green mucus or tinged with blood.
Fever.
Breathing quickly and feel short of breath.
Shaking and "teeth-chattering" chills.
Chest pain when coughing or breathing
Rapid heartbeat.
Easily Tired or feeling very weak.
Nausea and vomiting.
Diarrhea.
Symptoms of pneumonia caused by a virus similar to those caused by bacteria. But slowly and consequentially worse than bacteria.

Diagnosis of Pneumonia

Usually the doctor will ask about symptoms and physical examination. And further investigation needs to be done X ray and blood test. This is usually enough for doctors to find out if you are affected by pneumonia or not. If you need further tests will be done by checking the mucus from the lungs to determine if you have pneumonia or not. If there are symptoms get worse or have other health problems, to choose the best treatment for you.

Healing Pneumonia

If pneumonia is caused by bacteria, antibiotics can provide. The use of antibiotics should be in accordance with the instructions and the dosage given by the doctor.

There are things that can be done so quickly in healing. Plenty of rest and sleep, and reproduced drinking water. Do not smoke. If your cough is keeping you awake at night, talk to your doctor about using cough medicine.

You may need to go to the hospital if you have symptoms of poor and declining immunity or other serious illnesses.

Pneumonia caused by a virus usually not treated with antibiotics. Sometimes, antibiotics can be used to prevent complications. In the case of influenza virus pneumonia where A or B are considered causative agents, patients are seen within 48 hours of onset of symptoms may benefit from treatment with oseltamivir or zanamivir. Respiratory syncytial virus (RSV) can be treated with ribavirin. Herpes simplex virus and varicella-zoster virus infection is usually treated with acyclovir, while ganciclovir used to treat cytomegalovirus. There is no known efficacious treatment for pneumonia caused by SARS coronavirus, adenovirus, hantavirus, parainfluenza or H1N1 virus. (Wikipedia.org)

How can I prevent pneumonia?

By adopting a healthy lifestyle, and keep the environment in which we live is a good start to prevent pneumonia. Prevention can also be done with the pneumococcal vaccine, this vaccine will prevent you from pneumonia origin accompanied by implementing healthy living and a clean environment. Wash hands after doing something. This helps prevent the spread of viruses and bacteria that can cause pneumonia.

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UK: Probable Source Of Legionnaires Outbreak Indentified

Legionella Bacteria - Photo Credit CDC PHIL

 

# 6461

 

The outbreak of Legionella in the UK I wrote about last week (see HPA Updates The Stoke-On-Trent Legionella Outbreak) has expanded to 18 cases, and today the HPA has announced that they believe they have tracked down the bacteria’s source.

 

It appears that 17 of the 18 cases visited a JTF Mega Discount Warehouse where hot tubs were displayed and sold.  Genetic fingerprinting has determined that the same strain of Legionella found in these patients was present in the hot tub.

 

As this was a unique strain, not previously encountered, the odds are pretty good they’ve found the source.

 

The legionella bacteria thrives in warm water, such as is often found in air-conditioning cooling towers, hot tubs, and even ornamental water fountains. Improper maintenance, or poor design, can lead to the bacteria blooming.

 

When aerated the bacteria can become airborne, and if inhaled by a susceptible host, can cause a serious (and sometimes fatal) form of pneumonia. 

 

This update comes from the HPA.

 

 

Stoke-on-Trent Legionnaires’ Disease Outbreak – probable source identified

30 July 2012

Public and environmental health experts investigating the Legionnaires’ disease outbreak at Stoke-on-Trent believe they have identified a probable source.

 

The probable source is a hot tub based at JTF Warehouse, City Road, Fenton, Stoke-on-Trent. We would like to emphasise that investigations are still ongoing. Environmental Health specialists from the Health and Safety Executive and Stoke-on-Trent City Council have taken and continue to take samples from sites across Stoke.

 

A spokesperson from the Health and Safety Executive said: "HSE continues to inspect premises where we are the enforcing authority and will do so until we have eliminated those sites from our investigations and are sufficiently assured there are no other possible sources."

 

The samples from the hot tub at JTF Warehouse were confirmed by the Health Protection Agency’s specialist laboratory in Colindale last night as being an unusual strain legionella bacteria. The strain matched those taken from patients. JTF warehouse are fully cooperating with the investigation.

 

Dr Sue Ibbotson, regional director, Health Protection Agency West Midlands said: “We have identified the probable source of the Legionnaires' disease outbreak in Stoke. We have the evidence from DNA fingerprinting of samples from the hot tub and the patients being caused by the same previously unseen strain of legionella. The HPA also took detailed histories from the confirmed cases and we know that 17 of the 18 confirmed cases visited this warehouse in the two weeks before they fell ill. Added to that we know that spa pools are known to be effective mechanisms for spreading legionella infection.

 

“We may still expect to see new cases of Legionnaires’ disease related to this outbreak. JTF Warehouse decommissioned the hot tub on 24 July. It can take up to two weeks following exposure for people to develop symptoms of Legionnaires’ disease and a further few days before they go to see their GP. We continue to work with our partners to investigate this outbreak and continue to take samples across the city in case there are other sites with the same strain of legionnella.”

(Continue . . . )

 

For an even more unusual source of Legionella, you may wish to revisit a blog from 2010 where we looked at a Study: Wiper Fluid And Legionella.

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HPA Updates The Stoke-On-Trent Legionella Outbreak

 

Legionella Bacteria - Photo Credit CDC PHIL

# 6450

 

Yesterday Crof reported on the UK: Legionnaires' disease outbreak in Stoke-on-Trent that involved 7 patients hailing from that city in Staffordshire, England.

 

Today, we’ve an update from the HPA indicates that two more cases have been identified, and that early microbiology testing is consistent with there being an (as yet, unidentified) common source.

 

 

3.00pm update on Legionnaires' disease in Stoke-on-Trent

25 July 2012

Two further case of Legionnaires' disease have been confirmed in the Stoke-on-Trent outbreak bringing the total number of cases to nine. All those affected are between their late 40s and mid 70s and are being treated at University Hospital of North Staffordshire. The Health Protection Agency (HPA) is also investigating two cases identified in early summer as being possibly linked to the current cluster.

 

Professor Harsh Duggal, Director of the Health Protection Unit in Stafford, said: “Early microbiology typing results back from the HPA laboratories show that samples taken from some of the patients look very similar so far and this is consistent with the cases having caught their infection from the same environmental source. We are taking detailed histories of the movements of the patients to see if there are similar patterns which would indicate a local source of infection.

(Continue . . . )

 

 

While an infectious pneumonia, Legionella is not a contagious disease.  It is transmitted environmentally, usually through water.

 

Legionella got it’s name after it was identified as the bacterial cause of a large pneumonia outbreak at Philadelphia’s Bellevue Stratford Hotel during an American Legion convention in 1976.

 

During this outbreak, 221 people were treated and 34 died.

 

We now know Legionella to be a major cause of infectious pneumonia, and that it can sometimes spark large outbreaks of illness.  According to the CDC between 8,000 and 18,000 Americans are hospitalized with Legionnaire's Disease each year, although many more milder cases likely occur.

 

For more information on the disease, the CDC maintains a fact sheet at Patient Facts: Learn More about Legionnaires' disease.

The bacteria thrives in warm water, such as is often found in air-conditioning cooling towers, hot tubs, and even ornamental water fountains. Improper maintenance or poor design can lead to the bacteria blooming.

 

When water is sprayed into the air the bacteria can become airborne, and if inhaled by a susceptible host, can cause a serious (and sometimes fatal) form of pneumonia.

 

While large outbreaks of Legionella are often traced to specific causes, quite often the source of the infection for sporadic cases remains a mystery.  

 

Today’s HPA announcement stresses that these cases are not hospital acquired, and that the authorities are working to identify the source.

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The Legionella Outbreak in South West Edinburgh

Legionella Bacteria - Photo Credit CDC PHIL

 

# 6370

 

There’s a rapidly spreading outbreak of Legionella in Scotland this week,  and I’ve details from the NHS and HSE. 

 

But first . . . a little background and history.

 

In July of 1976, while many of us in the health care field were waiting for the expected arrival of a swine flu pandemic (see Deja Flu, All Over Again), another medical crisis was brewing  at the Bellevue Stratford Hotel in Philadelphia.

 

This was the scene of the gathering of hundreds of veterans belonging to the American Legion, celebrating this country’s bicentennial.  Within a couple of days of their arrival, scores fell ill with a serious flu-like illness.

 

At first, many believed this was the first arrival of the expected flu pandemic, but soon it became evident that this was something else entirely.  But exactly what it was would take months to determine.

 

During this outbreak, 221 people were treated and 34 died.

 

But it wouldn’t be until early in 1977 that a definitive cause would be isolated by the CDC – a Gram negative, aerobic bacteria found growing in the hotel’s air-conditioning cooling tower – that provoked a serious form of pneumonia.

 

Dubbed `Legionnaire's Disease’ by the press, this bacterium was named Legionella, and the pneumonia it produces Legionellosis.

 

While `discovered’ in 1976 and identified the following year, Legionella had been with us, and causing serious illness, for a long time. It had caused earlier outbreaks, including one in Austin, Minnesota in 1957 (Osterholm et al., 1983) and at Saint Elizabeth’s Hospital in Washington, D.C. in 1965.  

 

The cause of these outbreaks wasn’t identified, however, until retrospective studies were conducted after the Philadelphia outbreak.  

 

We now know Legionella to be a major cause of infectious pneumonia, and that it sometimes sparks large outbreaks of illness.  According to the CDC between 8,000 and 18,000 Americans are hospitalized with Legionnaire's Disease each year, although the actual number of infected is likely higher.

 

All of which serves as prelude to the following report on the rising number of Legionella cases being diagnosed this week in Edinburgh Scotland.

 

As of today, the Associated Press is reporting 51 confirmed cases (link), one death, and more cases are expected to turn up.

 

So far, the source of this environmental pneumonia has not been identified.

 

 

Running point in the investigation is NHS Lothian, which is the public health authority for the Edinburgh area. 

 

The first press release on this outbreak came 4 days ago with the announcement of the first four cases. The next day there were six,  and the day after that . . . thirteen. 

 

Now the number stands at 51, and at least 10 more suspected cases are being tested.

 

You can read the progression of daily reports by the NHS at the link below, with the last update from yesterday.

 

Outbreak of Legionella in South West Edinburgh - Last updated 07/06/2012 AM

Update - 07/06/2012 AM

The Cabinet Secretary for Health & Wellbeing made a statement on the Legionella Outbreak at the Scottish Parliament this morning. You can watch it online at 

http://www.scottish.parliament.uk/newsandmediacentre/30912.aspx

---

Update - 06/06/2012

Resilience team report on outbreak latest

The latest reports from the Scottish Government Resilience Room (SGoRR) on the Edinburgh Legionnaires’ outbreak show that there are now 21 confirmed cases and 19 suspected cases.

 

One of the confirmed cases has died, two have been discharged from hospital and 12 are being treated in intensive care.

 

An emergency information leaflet will be delivered to all homes and businesses in affected areas tomorrow. GPs have also been provided with information on spotting the signs of infection.

 

A dedicated NHS helpline has been set up for anyone concerned and can be reached on 0800 0858 531.

 

Health Secretary Nicola Sturgeon said:

 

“The fact remains that the risk to the general public is low – however, due to the incubation period of the infection we are still expecting to see an increase in cases over the next couple of days.

(Continue . . . )

 

 

Obviously these numbers continue to rise, and press reports now differ from the numbers posted above.

 

The NHS maintains the following  website with more information on Legionella:

 

Legionnaires' disease

Introduction

Legionnaires’ disease is a potentially fatal lung infection (pneumonia) that is caused by the legionella bacteria. Legionnaires’ disease is caught by breathing in small droplets of contaminated water. It is not contagious and cannot be spread directly from person to person.

 

Initial symptoms include a high fever and muscle pain. Once the bacteria begin to infect your lungs, you may also develop a persistent cough (see Legionnaires disease - symptoms). Prompt treatment using antibiotics is essential to reduce the risk of death. See Legionnaires’ disease - treatment for more information.

(Continue . . . )

 

 

To put this in context, the largest outbreak of Legionnaires disease in recent years in the UK occurred a decade ago, in the town center of Barrow-in-Furness, Cumbria which ultimately produced 180 known infections, and 7 deaths.

 

The following 62-page report on that outbreak is available on the HSE website:

 

Report of the public meetings into the legionella outbreak in Barrow-in-Furness, August 2002

 

While doctors struggle to treat those infected, disease detectives in Scotland are working to find the environmental source of this virulent bacteria, in order to stop the outbreak.

 

I’ll update this story when new details emerge.

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CIDRAP: MRSA Pneumonia Suspected In Calvert County Flu Cluster

 

Clumps of methicillin-resistant Staphylococcus aureus – Credit CDC PHIL

# 6210

 

 

Although we haven’t seen any official updates since late yesterday afternoon, reports have been trickling in through various media outlets suggesting that the fatal flu cluster in Lusby, Md.  involved the seasonal H3N2 virus and an aggressive form of MRSA pneumonia.

 

Lisa Schnirring of CIDRAP News  brings us up to date this evening with this report.  Follow the link to read her report in its entirety.

 

 

MRSA pneumonia suspected in fatal flu cluster

Lisa Schnirring Staff Writer

Mar 8, 2012 (CIDRAP News) – Another family member linked to a fatal flu cluster in Calvert County, Md., has been hospitalized, as suspicion grew that an aggressive drug-resistant form of pneumonia may have played a role in the severe illnesses, according to media reports.

 

Maryland and Calvert County health officials didn't report any new details about the cases, but the Washington Post reported yesterday that the sister of the 81-year-old woman who died has been hospitalized at MedStar Washington Hospital Center with fever but no other flu symptoms.

(Continue . . . )

 

 

Tissues taken during autopsies from two of the victims have reportedly been sent to the CDC for further analysis, which can take a day or two to complete.

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Follow Up On Korea’s `Mystery Pneumonia’

 

 

# 5801

 

 

Nearly 4 months ago, in The Korean `Mystery’ Pneumonia, I wrote about confusing, incomplete, and sometimes contradictory reports regarding a number of pregnant women in a Seoul Hospital with a `mystery’ respiratory virus.

 

At the time, there were 8 pregnant women, and 1 man - who came from different hospitals and  clinics across Korea – suffering from an unusually aggressive (and rapidly fulminating) form of  Idiopathic pulmonary fibrosis (IPF) – a scaring and stiffening of lung tissue without a known cause that normally takes months or years to manifest.

 

For more background on this story, FluTrackers has maintained this extensive thread with more than 120 entries to date.

 

Although this disease was being referred to as a `mystery virus’ in the media, its exact etiology (viral, bacterial, fungal, or environmental) was unknown.

 

After some impressive epidemiological detective work, the KCDC (Korea Centers For Disease Control) believes they have found a link between the use of a specific type of sterilizing fluid used in home humidifiers and this illness.

 

While not yet able to establish a firm cause-and-effect relationship between exposure to fumes from this sterilizer and this respiratory disease, they have found that those who were exposed to it in their home humidifier were 47 times more likely to develop the condition than a control group.

The exact chemical used in this sterilizing solution was not specified by the KCDC. For now they are urging the public not to use chemical disinfectants in their home humidifiers, and to change the water daily and clean them with detergent instead.

 

The KCDC said that pregnant women were likely more susceptible to this lung damage because they spent more time at home resting, and because they tended to take deeper breaths.

 

A full report from the KCDC is expected in the coming months.

 

A couple of news items on this story include:

 

Mystery malady traced to fluid in humidifiers – Korea JoongAng Daily

Steriliser blamed for mysterious S. Korean deaths – AFP

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South Korea: Ministry Probes `Mystery’ Disease

 

 

# 5624

 

 

A brief update to yesterday’s blog Catching Up With The Korean `Mystery’ Pneumonia which mentioned the first suspected family cluster  (mother/daughter) in the recent spate of Idiopathic pulmonary fibrosis (IPF) cases being treated at a Seoul Hospital.

 

The Korean Herald (h/t Alert on FluTrackers) is reporting today that a second child in the above mentioned family – a 1 year old – is also suspected of suffering from IPF, although the child is too young for  lung biopsy and so the diagnosis is not certain.

 

 

Ministry probes mystery disease

2011-06-13 18:25

The government is keeping a close watch on three members of a family reportedly suffering from idiopathic pulmonary fibrosis.

The disease is thought to be similar to the mysterious virus which recently killed three pregnant women.

(Continue . . . )

 

 

As the story tells us, although there are many unanswered questions surrounding these cases, the Korean government continues to offer assurances that whatever the cause – they do not believe it to be an infectious disease.

 

The story also points out that while these cases are similar, they may not be related to the earlier cases (see The Korean `Mystery’ Pneumonia) reported in April and May.

 

The Korean language press has been covering this story fairly extensively, and you’ll find an ongoing thread at FluTrackers with many machine translations.

 

While sometimes useful, these automated translations tend to be difficult to interpret, and so I use them sparingly.

 

For now, the good news is that whatever the cause (viral, bacterial, fungal, environmental) of these illnesses - the number of cases remains small - and there are no obvious signs of human transmission.

 

Of course, this story continues to evolve and we’ll keep an eye on it.

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Study: PPIs & Increased Pneumonia Risk

 

 

 

#  5561

 

 

PPIs  are Proton Pump Inhibitors – a group of drugs that greatly reduce gastric acid production and are used for the treatment of Dyspepsia, Peptic ulcer, GERD, Barretts esophagus, and other gastric conditions.

 

These drugs are available as prescription (Nexium, Dexilant, Prilosec, Zegerid, Prevacid, Protonix, Aciphex, Vimovo) medications and over-the-counter (Prilosec OTC (omeprazole), Zegerid OTC (omeprazole), Prevacid 24HR (lansoprazole)) remedies.

 

Like all medicines, the use of PPIs carry with it some risks, and those must be weighed against the (sometimes considerable) health benefits of taking them.

 

Last year the FDA warned consumers to:

 

• Be aware that an increased risk of fractures of the hip, wrist, and spine have been reported in some studies of people who use PPIs. The greatest increased risk for these fractures was seen in those who receive high doses of these medications or use them for a year or longer.
• Read and follow the directions on the “Drug Facts” label when considering the use of an over-the-counter PPI.
• Be aware that the over-the-counter PPIs should only be used as directed for 14 days for the treatment of frequent heartburn. If your heartburn continues, talk to your health care professional. No more than three 14-day treatment courses should be used in one year.

 

Prolonged use of PPIs has also been associated with low magnesium levels, increased incidence of Clostridium difficile,  and a number of studies – going back several years – have suggested a link between their use and increased risks of hospital and community acquired pneumonia.

A couple of examples include:

 

In 2009, Herzig et al. wrote in a JAMA article (doi: 10.1001/jama.2009.722) that : In this large, hospital-based pharmacoepidemiologic cohort, acid-suppressive medication use was associated with 30% increased odds of hospital-acquired pneumonia. In subset analyses, statistically significant risk was demonstrated only for proton-pump inhibitor use.

 

Earlier this year, the CMAJ published a systematic review and meta-analysis of the literature on PPIs (CMAJ. 2011 Feb 22;183(3):310-9) that found: Use of a proton pump inhibitor or histamine(2) receptor antagonist may be associated with an increased risk of both community- and hospital-acquired pneumonia. Given these potential adverse effects, clinicians should use caution in prescribing acid-suppressive drugs for patients at risk.

 

Which brings us to today’s study, which adds some more weight to the concerns expressed by these earlier studies.  

 

This time, the study appears in the European Respiratory Journal, and it suggests that recent initiation (< 30 days) of PPI treatment was associated with a three-fold increased risk of CAP (community acquired pneumonia).

 

Microbial evaluation of proton pump inhibitors and the risk of pneumonia

S.C.A. Meijvis, M.C.A. Cornips, G. Paul Voorn, P.C. Souverein, H. Endeman, D.H. Biesma, H.G.M. Leufkens, E.M.W. van de Garde

 

The authors compared the characteristics of 430 hospitalized adults admitted with community-acquired pneumonia against 1,720 patients from a population control group.  The authors write:

 

'After adjusting for co-morbidities, age, sex and pneumonia severity score, recent PPI initiation was independently associated with intensive care unit admission, although this was a small patient group.'

 

 

None of this should be viewed as a condemnation of PPIs, of course.  For many patients, their use can improve the quality, and even duration, of their lives.

 

While a number of studies have indicated an increase in the relative risk of developing complications such as pneumonia and bone fractures, in terms of absolute risk, the dangers appear relatively small.

 

Of course, if you are taking PPIs – or any medication for that matter – that you don’t really need to be taking, you are incurring a health risk without enjoying an offsetting therapeutic benefit.

 

Which means that even though they are available O-T-C, you should discuss using PPIs with your health care provider, especially if you intend to use them longer than the FDA recommended maximum of three 14-day treatment courses in one year.

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Statins & Pneumonia: Revisited

 

# 5465

 

 

The idea certainly isn’t new.  

 

If fact, I mentioned it in this blog as far back as 2006, and have written about it extensively probably a dozen times since then.  

 

While unproven, and not without controversy, over the years we’ve seen several studies suggesting that taking statins - cholesterol reducing drugs - can improve survival rates among those with influenza and/or pneumonia.

 

Dr. David Fedson – former Professor of Medicine at the University of Virginia School of Medicine and formerly Director of Medical Affairs, Aventis Pasteur MSD - has long championed the idea that we should be looking at statins for pandemic flu, which he believes may help modulate the immune response.

 

A couple of his papers on the subject include:

 

Pandemic Influenza: A Potential Role for Statins in Treatment and Prophylaxis

David S. Fedson^a

 

New Approaches to Confronting an Imminent Influenza Pandemic

Dr. Fedson and Peter Dunnill, DSc,FREng

 

 

In 2007 we saw a study that seemed to support the idea, one that indicated that statins lowered the mortality rate of people with pneumonia.

 

 

Statin drugs lower respiratory death risk: study

Tue Apr 10, 2007 12:40pm EDT

By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) - People who use statin drugs are less likely to die of influenza and chronic bronchitis, according to a study that shows yet another unexpected benefit of the cholesterol-lowering medications.

 

And in 2008 this encouraging report made the headlines:

 

Statins may cut pneumonia death, blood clot risks

27 Oct 2008 20:00:13 GMT

Source: Reuters

By Will Dunham

WASHINGTON, Oct 27 (Reuters) - Cholesterol-fighting drugs known as statins reduced the risk of dying from pneumonia or developing dangerous blood clots in the legs, adding to a growing list of benefits from the popular drugs, two research groups said on Monday.

 

 

But not all of the studies have been positive.

 

In July of 2009 there was a report that found no evidence of benefit among pneumonia patients (see Another Take On Statins And Pneumonia) taking statins.

 

 

But another study, presented in October of 2009 at the annual meeting of the IDSA, the Infectious Diseases Society of America, in Philadelphia suggested the opposite - that statins cut the mortality rate for seasonal flu by 50%.

 

Maryn McKenna writing for CIDRAP brought us the details.

 

Statins may help patients with severe seasonal flu

Maryn McKenna Contributing Writer

Oct 29, 2009 (CIDRAP News) – Commonly available drugs that are sold in lower-cost generic versions improve the survival of patients hospitalized for seasonal influenza, researchers reported today, raising the possibility of a widely available treatment that could be used in a severe flu pandemic if other drugs are in short supply.

 

 

So while not all of these studies are in agreement, many of them have supported the notion that statins may be of considerable value during a pandemic, and may contribute to the survival rate of patients with pneumonia.

 

 

Today we’ve another study – this time by the London School of Hygiene and Tropical Medicine published in the BMJ – that looks at 6 month post-pneumonia survival rates among those taking statins, and those not taking these medications.

 

While there may be other factors at work here – and more research is needed - survival rates were considerably higher (87% vs 80%) among those already taking statins when they fell ill.

 

As of this posting, the study has not appeared on the BMJ website.  I assume it will shortly. 

 

Here are excerpts from the LSHTM press release:

 

 

Pneumonia death rate lower among people who take statins

Tuesday, 5 April 2011

LSHTM study finds evidence for protective effect of cholesterol-lowering medication

 

Taking statins could help prevent people dying from pneumonia, according to a study by the London School of Hygiene and Tropical Medicine.

 

The researchers found that the risk of death in the six month period after diagnosis of pneumonia was substantially lower among those who were already receiving the cholesterol-lowering drugs compared with those who were not.

 

Previous studies have suggested that statins may be associated with a more favourable outcome after bacterial infection.

 

This study, published online in the BMJ today, supports a possible protective effect of statins against mortality in patients with pneumonia.

 

But the researchers point out that as they looked at patients who were already taking the medication when they developed pneumonia, a randomised clinical trial is needed to determine whether starting a statin at the time of diagnosis has a similar effect.

(CONTINUE  . . . . )

Notes to Editors:

Title of study online at BMJ: “Effect of statin treatment on short term mortality after pneumonia episode: cohort study” by Ian Douglas, Stephen Evans and Liam Smeeth.

 

 

The $64 question is whether administering statins after a pneumonia diagnosis provides any protective benefits.  There are reasons to believe that it might, but further studies are needed to prove or disprove it.

 

If you’d like to learn more about Dr. David Fedson and some of his ideas on statins, there are three 1-hour radio interviews available from 2009 that were conducted by Sharon Sanders of FluTrackers. 

 

You’ll find them archived at the FluTrackers links below.

 

David Fedson 06 April 2009

http://www.flutrackers.com/forum/aud...pril062009.mp3

David Fedson 18 May 2009

http://www.flutrackers.com/forum/aud...May18.2009.mp3

David Fedson 02 November 2009

http://www.flutrackers.com/forum/aud...Nov02.2009.mp3

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