http://tinyurl.com/mw5cu Study of ICU admissions for community-acquired pneumonia (CAP). 172 adult ICUs across England, Wales and Northern Ireland, 1995 to 2004.
The main findings of this study, the largest study of CAP admissions to ICU published worldwide, are of the progressive rise in the number of admissions with time and the survival of half of all cases. While CAP accounts for only a small proportion of total ICU admissions, the rise in the number of CAP cases has been disproportionately large in comparison to the rise in ICU admissions overall. Illness severity, whether judged by admission gas exchange parameters, APACHE score, septic shock, length of hospital stay or mortality, does not appear to have altered sufficiently to explain this large increase
Admissions were selected as having probable pneumonia if the recording of the primary reason for admission, or ultimate primary reason for admission if the diagnosis changed after 24 hours, was any of ‘Bacterial pneumonia’, ‘Viral pneumonia’ or ‘Pneumonia, no organism isolated’.
There was a 128% increase in admissions for CAP from 12.8 per unit to 29.2 per unit during the study period compared to only a 24% rise in total ICU admissions. ICU mortality was 34.9%, ultimate hospital mortality 49.4%. 46.3% mortality in those admitted to the ICU within 2 days of hospital admission, 50.4% in those admitted at 2 to 7 days, 57.6% in those admitted after 7 days following hospital admission.
CAP makes up a small, but important and rising, proportion of adult ICU admissions. Survival of over half of all cases vindicates the use of ICU facilities in CAP management. Nevertheless, overall mortality remains high, especially in those admitted later in their hospital stay.
• Community acquired pneumonia accounts for 6% of admissions to adult, general ICUs in the UK.
• Mortality was high, with 35% of admissions not surviving the ICU stay and 49% not surviving to leave hospital.
• Mortality increased with increasing time in hospital prior to ICU admission.
Arizona Department of Health Services bulletin, Sept/Oct 2005
“Viral pathogens can cause community-acquired pneumonia and are frequent in mild cases not requiring hospitalization. The principal causes are Influenza A and B, Respiratory syncytial virus (RSV), Parainfluenza virus and Adenovirus. Influenza and RSV are seasonal pathogens with clustering in the fall and winter months. Mycoplasma pneumoniae is the most frequently established diagnosis in out-patient pneumonias, and accounts for ~20% of cases. Given the diversity of causes of community-acquired pneumonia ‘it is not necessary or desirable to order diagnostic tests for each possible microorganism’.
http://www.jabfm.org/cgi/content/full/17/6/466
Human metapneumovirus is an emerging human respiratory pathogen first discovered in 2001.
The bacterial or viral agent responsible for an ARI is often uncertain. In 40% to 60% of community-acquired pneumonias, the pathogenic agent remains undetermined. A similar situation exists with ARIs that are presumed to be viral. Two or more causative agents probably occur more frequently than are currently documented.
In the last decade, the bird flu (avian influenza A, H5 N1), severe acute respiratory syndrome (SARS) coronavirus, and human metapneumovirus (HMPV) have been discovered, their viruses isolated, and clinical data from infected patients compiled and published. Recent research indicates that HMPV is the cause of an important proportion of acute upper and lower respiratory tract infections in all age groups. One hundred percent of 72 stored serum samples from children and adults collected in 1958 were positive for HMPV, indicating that the virus has been circulating in human populations for years.
In infants and children, lower respiratory tract illness caused by HMPV is similar to other viral-associated bronchiolitis and cannot clinically be distinguished from the RSV, influenza, and parainfluenza viruses.
HPMV overlaps with SARS in signs and symptoms. A report says that 40% of 48 patients admitted to a Hong Kong hospital with suspected SARS were infected with HMPV alone, 12% had HMPV plus SARS, and 10% had SARS alone. A similar finding has been reported from Toronto. A 40 year-old man who met WHO’s criteria for probable SARS was discovered to have died of HMPV pneumonitis on postmortem.
Glo:
Without a shred of evidence like you’ve provided above (thanks) I can say as a full time HCW increased numbers of respiratory illness among the non immunosuppressed seems to have increased. We’re seeing cases of empyema and collapsed lungs in people who are in late thirties and early forties. It’s July and a hundred degrees out there! Five years ago these admissions at this time of the year were rare or in older immiunosuppressed patients. Children are sucking on inhalants in restuarants, in Home Depot, and I’ve wondered if I’ve just gone stir (flu) crazy. My friends just think I’ve become super vigilant and its always been that way. My guess is if we could find out how many bronchial inhalers have been prescribed over the last few years the numbers might point the way. I will check the charts on sputum samples for this HMPV but since I was just checking them twelve hours ago, I pretty certain that test wasn’t run.
Have other health care workers noticed this?
Higher frequency of Respiratory infections is evident, but I’m more concerned about the persistence of a large proportion beyond 2 weeks.
These persistent infections seem to have the ability to go latent and re-emerge months later. I’ve watched any number of cases last 6–8 weeks, go latent for 2–3 months and then re-infest for weeks again. Sometimes 3 cycles per year.
Mycoplasma is a culprit in many of these cases.
Just from a non-medical point of view, this past year alone I had three friends and two others I know of (all in their early 40′s) hospitalized for long periods with pneumonia. To me that seems high for a low risk group in a tiny little town like ours. Lots of cases of kids with it this year as well.
Leo7 - perhaps the increase in your area is exactly because of the heat - not because it’s “the flu season” per se, but becuase it’s so hot and people are spending so much time indoors, not getting enough fresh air, plus increasing their exposure to others?
NS1 - Mycoplasma is a culprit in many of these cases.
Documented or presumptive? I had “mycoplasmic pneumonia” last July. I’m hugely healthy, no allergies, no nuthin’. I never get what everybody else gets. It was a presumptive dx, with no labs. Flavor of the day. Either way, I got over it.
Some studies say that in as much as 40% of LRI/bronchiolitis/pneumonia dx, a causitive organism is not identified. In my neck of the woods, a diagnosis tends to go by trend - whatever the provider has seen a bunch of, in the same time period. No big deal, you either get better or you don’t regardless of identification, and probably the modality of treatment wouldn’t differ. But for epidemiological purposes, this is obviously not ideal.
Would it be a good idea for my family to get the PNEUMOVAX 23?
bump?
Watch Dog, that’s my question, too.
If anyone in you family has known risk factors for pneumonia (chronic pulmonary disease, over 65, immunocompromised) you are a good candidate for pneumovax.
Melanie – at 22:22
My question pertains to the title of this thread “Observed Increases in Rates of Respiratory Illness”
If these “observed Increases” are impacting everyone, then maybe PNEUMOVAX 23 should be taken by everyone?
If there is a pandemic on the way should all get the PNEUMOVAX 23 also?
bump
Watch Dog and others:
I have not taken the Pneumovax vacc. I don’t usually have problems with respiratory involvements, but if I did I would. If I had a chronic illness or over the age of 55 I would. Many of the malingering pneumonias are bacterial not viral and therefore the vacc would be effective. The vacc will not help one iota if you go into a viral pneumonia from an influenza though so don’t forget that. We saw several patients with viral pneumonia too, it depends on your infection.
I find (my experiences) a lot of people medicating themselves with cough suppressants almost every three-four hours so they can go to work or sleep (at the beginning of the illness). I think it’s poor personal care habits that lead to pneumonia in a lot of cases. Here are some examples—Over half of them are medically dehydrated or borderline dehydrated—making sputum so thick it can’t be expectorated. Older women complain coughing causes urinary leakage so they suppress the reflex and don’t drink water either. People will smoke even though their lips are blue and ears gray, parents let kids sleep and sleep lying supine or down, instead of making them sit up and cough into tissues at intervals, or take deep breaths and spit out sputum into toilet or tissue, or wash their hands after this. For infants there are humidifers and suction bulbs that parents rarely use, but they will sit for eight hours in an ED crying over sick babies. I’ve been surprised by older kids who don’t cough the sputum up and spit it out and their parent’s don’t make them. Where do they think the sputum will go if it’s not coughed up? It settles like sludge in the lungs. If anything I wrote vaguely resembles you—get the vaccine now.
Whatever you do learn self care habits in good pulmonary hygiene and put them into practice even with minor colds.
This is my personal opinion and I have no links to provide—but if we do see a pandemic you will see suggestions to get the flu and pneumovax vaccines together because there is really not much else to offer in the long run.
Leo7 – at 17:43
“Many of the malingering pneumonias are bacterial not viral and therefore the vacc would be effective. The vacc will not help one iota if you go into a viral pneumonia from an influenza though so don’t forget that.”
Thank you,
So when a person with H5N1 gets sick, do they come down with bacterial or viral pneumonias?
Watch Dog:
Good question. Tom DVM and others have pointed out due to the very fast and killing machine that H1N1 was in 1918, the pneumonias that killed had to be viral. I agree this was the case for those who died quickly and from the cases in Indonesia I would say probably the same-viral(although I don’t have a medical document to back that up). That said, there is a certain component of people who frequently get respiratory infections and incur bacterial infections through sinus infection as an example (very common). There are people who get into coughing jags while they are lying totally supine while sick with flu or bad cold and aspirate their stomach contents into their lungs setting up a bacteria pneumonia. But mostly it’s the immunosuppressed who get impressive bacterial infections from the common cold.
If you get H5N1 a viral pneumonia is most likely unless something else happened like I mentioned above. If you’re the type wanting to cover all bases or if someone in your family is immunosuppressed it’s an option as long as the supplies aren’t too low.
The secondary bacteria infections generally invade a host after the primary illness as been fought off and the patient remains weak, has co infections, or they’re immune systems are shot or ineffective. It’s in this regard that many have suggested the Pneumovax may be helful. You survive the flu only to be taken out by a bacterial pneumonia. Hope this helps.
Guys, the point of the articles that I posted was not about getting sick. These articles are showing that there are notable increases in respiratory illness. And sort of everywhere geographically. An H5N1 infection may look just like any other cold or “bug going around” the school or office.
Also the point - in as much as 40% of respiratory illnesses, no critter is tested for. One journal said that because there is so much of the illness,‘it is not necessary or desirable to order diagnostic tests for each possible microorganism’. treatment is effective anyway.
Most of the time, one respiratory illness looks, sounds and feels like any other, no matter what the cause of it is, from colds to bronchitis to pneumonia that puts you in the hospital. Most of the time, we don’t actually know what caused it, but we know how to treat it. Really oversimplified, if something’s bacterial, it’ll respond to antibiotics. If it’s viral, it won’t. H5N1 is viral.
We want to know when the pandemic is going to happen, but seeing increased respiratory illness now and knowing that we don’t routinely test to see what the bug is, causes me to wonder how we would measure the onset of a pandemic if there were no poultry deaths and wild bird die-offs?
glo:
Didn’t mean to hijack your thread cause you’re on to something. Watchdog wanted answers and when no one else did, I tried. Your last sentence above—we wouldn’t but most of the cases are mild. I would expect a full blown H5N1 to hit like a sledge hammer. All those folks who wake up sick saying “I got to go in to work,” we’ll be saying, “I can’t breathe.”
sorry
Leo7 – at 18:41
“I would expect a full blown H5N1 to hit like a sledge hammer”
Why?? H1N1 slipped around the world in March 1918 and almost no one really noticed it. Came like a Sledge Hammer in August of same year as the second wave. What would stop H5N1 from doing the same thing????
I don’t mean to pre-empt anything the respiratory folks say cause they’re much more attuned to what’s happening than I am, but after reading the available material on the 1918 panflu the rapid onset of respiratory failure seems to be due to ARDS (Acute Respiratory Distress Syndrome). Pneumonias that set in later may be either viral or bacterial. The causes are many-ie BOOP- bronchiolitis obliterans organizing pneumonia; aspiration pneumonia caused by vomiting or aspiration of secretions while in a weakened state, consolidation of the lungs from being in one position, not turning or being able to take deep breaths, etc. Most post-flu pneumonias get treated as a bacterial pneumonia; BOOP is treated with steroids like prednisone.
No, the questions and comments are all good. I just wanted to clarify what my point was and that it isn’t about worrying about falling ill, but wondering how increased respiratory disease may affect tracking the onset of pandemic flu.
Watchdog, ask away. That is the point of the website. Pneumovax protects against bacterial pneumonia caused by the streptococcus pneumonae bacteria. It would not be effective for any virus or other bacterias, like a mycoplasm.
That was me.
Differences in viral pneumonia and ARDS (simply stated):
One half of pneumonia cases are viral and short lived.
Viral pneumonia-Inflammation to lungs caused by a virus. Begins with flu symptoms-12 to 32 hours later you see shortness of breath, increased coughing, high fever. 48 hours Blue tint to lips and extreme SOB. People generally start to improve.
ARDS-Adult respiratory distress syndrome-Pneumonia causes ARDS. There is major lung infection or injury. In 24–48 hours you see-shortness of breath, labored rapid breathing and low blood pressure. People do not improve and fade out of consciousness.
Blood pressure would be a hallmark sign of ARDS. There are of course differences in listening to lung sounds but that isn’t something you can learn by reading.
No such diagnosis as ARDS in 1918 that’s why all death certificates say flu or pneumonia.
Hope this helps some.
Everyone, Thank you!
http://www.nepalnews.com/archive/2006/jul/jul11/news07.php
Nepal/Bhutan - Respiratory illness grips refugee camps
“Respiratory illness with fever gripped Bhutanese refugee camps in Jhapa and Morang districts over the last fortnight.
The flu, which is a common occurrence in refugee camps around this time, has affected hundreds - both children and the adults. According to the UN refugee agency, the spread of flu started from June 26 with an incidence rate of 8 per 1000 persons and it the rate grew 11 per 1000 persons by July 03 but declined to 4 per 1000 persons by July 09.”
I think alot of the respiratory illnesses we see now adays in the US come from the prevalence of antibiotic usage. I have a friend whose children continually have colds, sinus infections, bronchitis, occasional pneumonia. She takes them to the doctor at the drop of a hat and demands antibiotics. One winter, all of her children were on antibiotics from October to April. Not only do people get weakened immune systems with frequent antibiotic usage, but those who use antibiotics inappropriately, like broad spectrum antibiotics for something that should have been cultured are often developing antibiotic resistence.
My husband and I are rarely ill, but a few years ago, we both got a wicked bronchitis that required medical treatment. My husband developed pneumonia and had to take two different antibiotics before his cleared up. I questioned our doctor regarding our symptoms and the level of treatment. He said he suspected that we ran across someone who had an antibiotic resistent respiratory infection.
Now, in the winter, we carry alcohol hand sanitizer with us wherever we go. Wash hands in hot soapy water.
AngieD~~
Like you and your husband noone in our family is ever sick…..that is, not enought to get antibiotics. After I heard about people taking them too much and you can build an immunity….I started chilling out about the sniffles etc…..You’ve got to be able to fight things on your own. NOw in your case…..you had to have them. What you said about your doctor saying that he suspected that you ran across someone who had antibotic resistent respiratory infection really scares me….especially during BF…..I also keep tons and tons of alcohol in my car…..do you know if with the heat in the car if it will loose its strength in killing germs….I keep it in the glove box…..
New Zealand - Manawatu Standard, 27 July 2006 - Winter chills push hospital to red alert
“Palmerston North Hospital is operating on red alert as patient numbers strain resources. Most patients have influenza or respiratory illnesses, though some showed angina-type symptoms on admission. “
Antibiotic resistent infections. Thi s will make your blood run cold.
Melanie at 3:49----charming little article you pulled up. It seems like extreme information, BUT, it’s ALL true and painstakingly accurate. We try to stay away from antibiotics at all costs.
The problem is when you run across someone who is spreading around bacteria that is antibiotic resistant. Like people who have a nasty sinus infection and start on an antibiotic. They begin to feel better and stop their antibiotic half the way through treatment. Then they get REALLY sick, go back to the doctor and then get a stronger antibiotic. Stop taking it when they start feeling better, but they’re not finished with the medicine. By then, they’ve got bronchitis and borderline pneumonia. Then you’re in trouble when you drop by the doctor’s office to pick up your once a year bloodwork results and Bronchitis Beatrice is sitting next to you in all her bacterial glory.
About 10–12 years ago I had a friend with 3 children. She would “save” their antibiotics for treating the next illness that came along though I’m sure the instructions were to FINISH the medication. These antibiotics would be dispensed to any family member who got sick, including the parents. And she was likely treating *viral* illnesses with the antibiotics at least some of the time because they often didn’t see a doctor for proper diagnosis because they had no medical insurance.
If there is/has been lots of this type of thing going on all over, well…..no wonder there’s a problem.
Also, is it “not unusual” for a 2-year old child to have pneumonia in the middle of the summer? Mild case - not hospitalized.
Closed to maintain Forum speed.