The University of Louisville journal of respiratory infections最新文献

{"title":"A Woman with a Lung Infiltrate and Brain Abscesses: Case Discussion from the University of Louisville Hospital","authors":"V. Corcino, Viswanathan Nagarajan, F. Arnold","doi":"10.18297/JRI/VOL3/ISS2/1","DOIUrl":"https://doi.org/10.18297/JRI/VOL3/ISS2/1","url":null,"abstract":"Dr. Veronica Corcino (Infectious Diseases fellow): A 61-year-old female with no history of systemic disease presented to an outlying hospital with a headache, seizure-like episode and progressive productive cough for one month who presented to the emergency room of an outlying hospital where two brain lesions were detected on a computerized tomography (CT) scan. She was transferred to this university hospital the same day. She initially complained of dry cough that progressed to be productive a month prior to admission, however she had refused to seek medical care. She lives in Grand Rapids, Michigan and decided to visit her daughter in rural Kentucky in the winter. Her family stated she had chills, fevers, generalized weakness and a poor appetite the day prior to admission. Eventually, her headache progressed and she developed a seizure-like episode with loss of consciousness, which prompted going to the hospital. On presentation, her temperature was 100.9° F, blood pressure 145/80 mm Hg, pulse 110 beats/minute, and respiratory rate 23 breaths/minute. Her oxygen saturation was 95% on ambient air. Admission laboratory tests, including blood cultures, were collected. (Table 1) A chest radiograph (Figure 1) and head CT were also obtained (Figure 2). Diagnostic Approach","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89985408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards Multi-Lingual Pneumonia Research Data Collection Using the Community-Acquired Pneumonia International Cohort Study Database","authors":"William A. Mattingly, Kimberley A Buckner, S. Pena","doi":"10.18297/JRI/VOL3/ISS1/2","DOIUrl":"https://doi.org/10.18297/JRI/VOL3/ISS1/2","url":null,"abstract":"Background: Although multilingual interfaces are preferred by most users when they have a choice, organizations are often unable to support and troubleshoot problems involving multiple user languages. Software that has been structured with multiple languages and data interlinking considerations early in its development is more likely to be easily maintained. We describe the process of adding multilingual support to the CAPO international Cohort study database using REDCap. Methods: Using Google Translate API we extend the supported Spanish language version of REDCap to the most recent version used by CAPO, 8.1.4. We then translate the English data dictionary for CAPO to Spanish and link the two projects together using REDCap’s hook feature. Results: The Community Acquired Pneumonia Organization database now supports data collection in Spanish for its international collaborators. REDCap’s program hook functionality facilitates both databases staying up to date. When a new case is added to the Spanish project, the case is also added to the English project and vice versa. Conclusions: We describe the implementation of multilingual functionality in a data repository for community-acquired pneumonia and describe how similar projects could be structured using REDCap as an example software environment. DOI: 10.18297/jri/vol3/iss1/2 Received Date: November 26, 2018 Accepted Date: December 20, 2018 https://ir.library.louisville.edu/jri/vol3/iss1/ Affiliations: 1Division of Infectious Diseases, University of Louisville This original article is brought to you for free and open access by ThinkIR: The University of Louisville’s Institutional Repository. It has been accepted for inclusion in The University of Louisville Journal of Respiratory Infections by an authorized editor of ThinkIR. For more information, please contact thinkir@louisville. edu. Recommended Citation: Mattingly, William A.; Buckner, Kimberley A.; and Pena, Senen (2019) “Towards MultiLingual Pneumonia Research Data Collection Using the Community-Acquired Pneumonia International Cohort Study Database,” The University of Louisville Journal of Respiratory Infections: Vol. 3 : Iss. 1 , Article 2. *Correspondence To: William A Mattingly, PhD Work Address: 501 E Broadway, Suite 120 Louisville, KY, United States, 40202 Work Email: bill.mattingly@louisville.edu ORIGINAL RESEARCH","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":"51 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91122522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Urine Levels of C-Reactive Protein with Clinical Outcomes in Patients with Pneumonia: A Pilot Study","authors":"Subathra Marimuthu, V. Salunkhe, S. Furmanek, L. Wolf","doi":"10.18297/JRI/VOL3/ISS2/2","DOIUrl":"https://doi.org/10.18297/JRI/VOL3/ISS2/2","url":null,"abstract":"Community acquired pneumonia (CAP) is a common and serious illness. Most CAP patients are treated in outpatient facilities and only 20% of CAP patients require hospitalization [1]. Among hospitalized CAP patients, the majority of deaths occur during the early days of hospitalization [2]. Early recognition of severity of CAP is essential for initiation of appropriate empiric antibiotic treatment, aggressive diagnostic work-up, and adequate supportive care. Management strategies for CAP patients depend on the severity of CAP and risk of mortality. In patients with severe CAP, a respiratory specimen does not always yield a positive microbiological culture or definitive pathogen. Furthermore, there is no single factor which can predict the severity of CAP [3].","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91208069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community-Acquired Pneumonia Pathogenesis in Patients with Chronic Obstructive Pulmonary Disease","authors":"J. Ramirez, R. Cavallazzi","doi":"10.18297/jri/vol3/iss2/4","DOIUrl":"https://doi.org/10.18297/jri/vol3/iss2/4","url":null,"abstract":"DOI: 10.18297/jri/vol3/iss2/4 Submitted Date: November 18, 2019 Accepted Date: November 18, 2019 Website: https://ir.library.louisille.edu/jri Affiliations: 1Division of Infectious Diseases, University of Louisville School of Medicine; 2Division of Pulmonary, Critical Care, and Sleep Disorders Medicine, University of Louisville School of Medicine This original article is brought to you for free and open access by ThinkIR: The University of Louisville’s Institutional Repository. It has been accepted for inclusion in the University of Louisville Journal of Respiratory Infections by an authorized editor of ThinkIR. For more information, please contact thinkir@louisville.edu. Recommended Citation: Ramirez, Julio A and Cavallazzi, Rodrigo. (2019) “Community-Acquired Pneumonia Pathogenesis in Patients with Chronic Obstructive Pulmonary Disease,” The University of Louisville Journal of Respiratory Infections: Vol. 3 : Iss. 2 , Article 4.","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73682754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current and Future Antivirals Medications to Treat Influenza: Mechanisms of Action","authors":"J. Ramírez","doi":"10.18297/JRI/VOL3/ISS1/9","DOIUrl":"https://doi.org/10.18297/JRI/VOL3/ISS1/9","url":null,"abstract":"Due to significant research efforts in the field of influenza therapy, in the near future we will have a series of new antivirals to treat patients with influenza. Most likely, hospitalized patients with influenza pneumonia as well as other severe forms of influenza will be managed with combination antiviral therapy. During the selection of antivirals, it will be important for physicians to have a clear understanding of the mechanisms of action of anti-influenza medications.","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":"29 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81009717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Pneumonia Severity Indices as Mortality Predictors","authors":"Connor English, T. Chandler, Brian E. Guinn, S. Furmanek, Julio A Ramirez","doi":"10.18297/JRI/VOL3/ISS1/7","DOIUrl":"https://doi.org/10.18297/JRI/VOL3/ISS1/7","url":null,"abstract":"Background: The leading cause of infectious disease death in the United States is communityacquired pneumonia (CAP). Several pneumonia severity indices exist and are widely used as tools to assist physicians regarding site of care based on risk of death. However, limited data exists that discerns which of the most commonly used severity scores is the best predictor of mortality across multiple time points. The objective of this study is to determine the best mortality predictor at different time points between four of the most commonly used pneumonia severity scores. Methods: This was a secondary analysis of a prospective, multicenter, population-based, observational study of patients hospitalized with CAP in the city of Louisville, KY. The severity indices used were the American Thoracic Society (ATS) criteria, the Pneumonia Severity Index (PSI), the British Thoracic Society criteria (CURB-65), Quick Sepsis-Related Organ Failure Assessment (QSOFA), and direct ICU admission to represent physician discretion. The accuracy, kappa statistic, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the ability to predict in-hospital, 30-day, 6-month, and 1-year mortality. 95% confidence intervals for each variable were generated by bootstrapping with random sampling and resampling of the subjects 1000 times. In addition, the area under the curve (AUC) was calculated for each severity score and mortality time point. Results: There were 6013 eligible patients included in this analysis with data collected between the years 2014 and 2016. At each time point, the QSOFA had the highest sensitivity and NPV, while the PSI had the highest specificity and PPV. QSOFA had the highest accuracy for in-hospital mortality, 30-day mortality, and 6-month mortality, and the CURB-65 had highest mortality for 1-year mortality. The QSOFA had the highest kappa statistic for in-hospital mortality, the CURB-65 had the highest kappa statistic for 30-day mortality, and the PSI had the highest kappa statistic for 6-month and 1-year mortality. The AUC was highest for the ATS criteria for in-hospital mortality, and was highest for the PSI at the remaining time points. Conclusions: The results of this study show that QSOFA and the PSI are the most reliable severity indices for mortality predictions based on these measures. QSOFA was found, on average, to have the highest accuracy, sensitivity, and NPV. Additionally, PSI was found, on average, to have the highest kappa statistic, specificity, and PPV. The AUC, on average, was best with PSI as the predictor. QSOFA is most capable of making true negative predictions and the PSI is the most capable of making true positive predictions across the four time points. DOI: 10.18297/jri/vol3/iss1/7 Received Date: November 20, 2018 Accepted Date: January 14, 2019 https://ir.library.louisville.edu/jri/vol3/iss1/ Affiliations: 1University of Louisville School of Medicine, Department of M","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86134077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severity of disease and mortality for hospitalized patients with community-acquired viral pneumonia compared to patients with community-acquired bacterial pneumonia","authors":"R. Kim, T. Chandler, S. Furmanek, T. Wiemken, R. Cavallazzi","doi":"10.18297/jri/vol3/iss1/3","DOIUrl":"https://doi.org/10.18297/jri/vol3/iss1/3","url":null,"abstract":"Background: There exists a large body of literature to help identify, diagnose, treat, and manage community-acquired pneumonia (CAP). Despite this, there is little data that directly compares the clinical syndromes and complications of pure bacterial pneumonia to pure viral pneumonia. Our study compares the clinical presentation, morbidity and mortality of viral vs. bacterial etiologies of CAP. Methods: This was a secondary data analysis of the Community-Acquired Pneumonia Organization (CAPO) international study database. Data was collected concerning patient demographics, physical examination findings, laboratory findings, radiological findings, severity of illness, and clinical outcomes and stratified according to the two study groups, CAVP and CABP. A microbiological diagnosis of CABP was based on the isolation of a bacterium from a respiratory sample, blood culture and/or identification of a urinary antigen for Streptococcus or Legionella; microbiological diagnosis of CAVP was based on polymerase chain reaction or antigen detection from respiratory samples. Results: Our study included 1,913 patients. Of these, 286 (15.0%) had viral infection, while 1,627 (85.0%) had CAVP. We found that bacterial CAP patients are older, more frequently male, and suffer from a higher proportion of comorbidities when compared to viral CAP patients. Comparison of physical exam findings and laboratory values failed to find a clinically significant difference between bacterial and viral CAP patients. When comparing severity of illness, bacterial CAP patients had greater frequency of PSI ≥ class IV; however, viral CAP patients more frequently needed ICU admission, ventilator support, vasopressor support, and had higher rate of in hospital mortality. Conclusions: Our study confirms the extreme difficulty differentiating CABP from CAVP using demographics, physical exam, or x-ray findings. We found no major clinical or laboratory findings distinguishing CABP from CAVP. The increased severity of illness of CAVP compared to bacterial etiologies shows that PSI scores may not be an accurate indicator of severity of disease. More studies are needed to identify the best process of care for patients with CAP, including the potential benefits of routine respiratory viral panel testing and empiric antiviral therapy. DOI: 10.18297/jri/vol3/iss1/3 Received Date: October 26, 2018 Accepted Date: December 18, 2018 https://ir.library.louisville.edu/jri/vol3/iss1/ Affiliations: 1Division of Pulmonary, Critical Care and Sleep Disorders, University of Louisville 2Division of Infectious Diseases, University of Louisville 3Saint Louis University Center for Health Outcomes Research (SLUCOR) This original article is brought to you for free and open access by ThinkIR: The University of Louisville’s Institutional Repository. It has been accepted for inclusion in The University of Louisville Journal of Respiratory Infections by an authorized editor of ThinkIR. For more information, please cont","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84474719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beta-lactam plus Macrolide vs Fluoroquinolone for Empiric Therapy of Hospitalized Patients with CAP: Results from the University of Louisville Pneumonia Study","authors":"V. Salunkhe, S. Furmanek, F. Arnold","doi":"10.18297/JRI/VOL3/ISS1/6","DOIUrl":"https://doi.org/10.18297/JRI/VOL3/ISS1/6","url":null,"abstract":"","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87197052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Real-time PCR assay for Pneumocystis jirovecii on the Luminex ARIES® Platform","authors":"Subathra Marimuthu, K. Ghosh, L. Wolf","doi":"10.18297/jri/vol3/iss1/5","DOIUrl":"https://doi.org/10.18297/jri/vol3/iss1/5","url":null,"abstract":"Pneumocystis pneumonia (PCP) is an opportunistic infection caused by the fungus Pneumocystis jirovecii. Infection with P. jirovecii can result in serious illness in patients with a weakened immune system, and can lead to death if it is not properly diagnosed and treated. Direct detection of P. jirovecii in lower respiratory tract specimens such as bronchoalveolar lavage (BAL) is preferred for rapid diagnosis, a laboratory service currently not available locally. We report here the development of a diagnostic real-time Polymerase Chain Reaction (PCR) assay using BAL specimens to detect P. jirovecii. By targeting the multi-copy mitochondrial large subunit ribosomal RNA gene (mtLSU rRNA) of P. jirovecii, assay sensitivity is increased. Primer pairs were designed to include a fluorescent reporter dye-labeled primer with a unique MultiCode® base pair isoC on the 5’end and one unlabeled primer. The performance characteristics were determined on the Luminex ARIES® instrument, combining DNA extraction, amplification and detection into a one-step process. The cassette contains the reagents needed to perform all of the steps including extraction, purification, amplification, and detection, plus a sample processing control. Accuracy, precision, sensitivity, specificity and stability studies were conducted to validate the assay to meet CLIA requirements. The analytical sensitivity was 89.1%, and the analytical specificity was 100%. The assay could reliably detect 200 organisms/ mL, crossing thresholds (Ct) and melt temperatures (Tm) were consistent, and no cross-reactivity was observed with other pathogens known to cause respiratory infections. The results demonstrated that these primers are specific to Pneumocystis jirovecii. The real-time PCR method using the ARIES® system allowed for rapid and sensitive detection of Pneumocystis pneumonia infections with P. jirovecii using clinical respiratory specimens. DOI: 10.18297/jri/vol3/iss1/5 Received Date: November 26, 2018 Accepted Date: December 20, 2018 https://ir.library.louisville.edu/jri/vol3/iss1/ Affiliations: 1Division of Infectious Diseases, University of Louisville This original article is brought to you for free and open access by ThinkIR: The University of Louisville’s Institutional Repository. It has been accepted for inclusion in The University of Louisville Journal of Respiratory Infections by an authorized editor of ThinkIR. For more information, please contact thinkir@louisville. edu. Recommended Citation: Marimuthu, Subathra; Ghosh, Kuldeep; and Wolf, Leslie A (2019) “Development of a Realtime PCR assay for Pneumocystis jirovecii on the Luminex ARIES® Platform,” The University of Louisville Journal of Respiratory Infections: Vol. 3 : Iss. 1, Article 5. *Correspondence To: Leslie A. Wolf, PhD Work Address: Infectious Diseases Laboratory, Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, Kentucky 40292 USA Work Email: lawolf07@louisville.edu ORIGINAL R","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79920835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Research in Pneumonia: Role of Artificial Intelligence","authors":"T. Wiemken, R. Kelley, William A. Mattingly, J. Ramirez","doi":"10.18297/jri/vol3/iss1/1","DOIUrl":"https://doi.org/10.18297/jri/vol3/iss1/1","url":null,"abstract":"Clinical research in pneumonia involves the creation and dissemination of new knowledge studying patients with pneumonia. The process of clinical research can be summarized in four steps: planning the study, performing of the study, analyzing the data, and disseminating study results. During the third step of data analysis, data are often examined to define if associations exist between independent variables (e.g. predictor variable or other variables in the model) and the dependent variable (e.g. outcome). This examination of the data is performed using two types of methods: 1) clinical analysis and 2) statistical analysis. During clinical analysis, the data are evaluated to define biological plausibility and clinical importance. During statistical analysis, the data are commonly evaluated to define statistical significance for the purposes of hypothesis testing, an approach termed ‘frequentist statistics’ [1].","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":"174 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87296069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}