Current opinion in pulmonary medicine
-
Fungal respiratory disease is associated with a high mortality in immunocompromised patients. This review aims to describe the recent advances in the aetiology, clinical presentation, diagnosis and management of fungal respiratory disease. ⋯ Invasive filamentaous fungal infections of lung remain important causes of death in immunocompromised patients. Development of new early diagnostic tools and well-designed multicenter evaluations of diagnostic methods and therapeutic regimens available at present are the important work in the next 2-3 years.
-
This review highlights recent advances in the aetiology of nosocomial pneumonia, and in strategies to increase accuracy of diagnosis and antibiotic prescription while limiting unnecessary antibiotic consumption. ⋯ Increasing antimicrobial resistance in nosocomial pneumonia both challenges treatment and mandates limitation of selection pressure by reducing antibiotic burden. Treating physicians should be both aggressive in initiating antimicrobials when suspecting nosocomial pneumonia but willing to discontinue antimicrobials when diagnostic results point to an alternative diagnosis. Efforts should be made to limit duration of antibiotic therapy when possible.
-
Pleural effusions, lung abscess and empyema remain a commonly encountered clinical problem and a significant source of morbidity. The aim of this review is to summarize recent developments with emphasis on controlled trials. ⋯ The major recent development in the management of pleural infections is the finding that we should dampen the ardor for the routine use of fibrinolytic agents in all patients with pleural infections. We strongly recommend the necessity for additional, well-designed trials to help determine optimal care for these seriously ill patients.
-
Bronchiolar abnormalities are relatively common and occur in a variety of clinical contexts. There have been an increasing number of terms, some of which are redundant, used in referring to various forms of bronchiolar disorders. The purpose of this review is to provide an updated classification scheme to facilitate the clinical approach to patients with suspected bronchiolar disease. ⋯ In the clinical approach to a patient with bronchiolar disease, primary bronchiolar disorders should be distinguished from predominantly parenchymal or large airway processes with bronchiolar involvement. The number of patterns of bronchiolar response to injury is limited and these patterns are generally non-specific in regard to cause. Appropriate diagnosis and management of patients with bronchiolar disorders depend on judicious correlation of clinical, physiologic, and morphologic manifestations.
-
Nontypeable Haemophilus influenzae is the most common bacterial pathogen associated with airway infection in chronic obstructive pulmonary disease, both in stable disease and during exacerbations. Past attempts to elucidate its role as a pathogen in this disease yielded confusing and contradictory results, leading to its designation as an 'innocent bystander' with little if any pathogenic role in exacerbations and stable disease. Application of modern understanding of bacterial pathogenesis and of innovative research methodologies, however, has considerably clarified its role. ⋯ Though much has been learnt about nontypeable H. influenzae in chronic obstructive pulmonary disease, new therapeutic and preventive approaches require an even greater understanding of this host-pathogen interaction.