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Pseudomonas Pneumonia

Pneumonia caused by Pseudomonas Aeruginosa Infection

Pseudomonas aeruginosa, a gram- negative bacteria, can cause pneumonia, an acute inflammation of the lungs. It can be primary, following aspiration of the bacteria e.g. in patients who are being mechanically ventilated or can be the result of bacteremic spread to the lungs.


Presentation

Pneumonia due to infection with P. aeruginosa occur as three distinct syndromes:

  1. Community-acquired pneumonia (CAP), usually affects persons with chronic lung disease.
  2. Hospital-acquired pneumonia (HAP), commonly occurs in ICU patients.
  3. Bacteremic P. aeruginosa, mostly in neutropenic hosts [1].

P. aeruginosa colonization can occur in airways damaged due to mechanical ventilation or a preceding viral infection, or trauma and is usually followed by acute pneumonia, sepsis, and death. As an etiology of ventilator-associated pneumonia, P. aeruginosa has a high mortality rate compared to other organisms [2]. The incidence of P. aeruginosa pneumonia is increased in patients with chronic obstructive pulmonary disease (COPD), nursing home residents, and patients recently discharged from a hospital [3].

Patients aged over 65 are at an increased risk for mortality from the bacteremic pneumococcal disease. In elderly persons, the expression of common signs and symptoms of pneumonia are usually obscured, atypical, or even absent [4] [5] [6].

Symptoms of pneumonia include a productive cough, severe dyspnea, fever, chills, cyanosis, confusion, and signs of systemic inflammatory response. On physical examination, fever, cyanosis, rales, rhonchi, retractions, and hypoxia may be detected. In patients with cystic fibrosis, clubbing, malnutrition, and an increased anteroposterior (AP) chest diameter can develop.

Fever
  • Symptoms of pneumonia include a productive cough, severe dyspnea, fever, chills, cyanosis, confusion, and signs of systemic inflammatory response. On physical examination, fever, cyanosis, rales, rhonchi, retractions, and hypoxia may be detected.[symptoma.com]
  • He presented with fevers, SOB and cough productive of thick purulent sputum and had a LUL infiltrate with sputum Cxs positive for MDR Pseudomonas aeruginosa.[pulmonaryroundtable.blogspot.com]
  • The patient presents with signs of severe systemic toxicity, and symptoms include fever, chills, dyspnea, cyanosis, confusion, and productive cough with green or yellow sputum. P. aeruginosa rarely causes disease in the healthy individual.[visualdx.com]
  • […] with hospital acquired pneumonia Microbiological diagnosis of P. aeruginosa serotype O11 HAP by lower respiratory tract specimen (BAL or miniBAL) and presence of a new or progressing pulmonary infiltrate, plus one of the three following criteria: a) fever[clinicaltrials.gov]
  • The infection can cause enteritis, with patients presenting with prostration, headache, fever, and diarrhea (Shanghai fever).[emedicine.medscape.com]
Pain
  • Community-acquired pneumonia is diagnosed by clinical presentation (e.g. fever, cough, pleuritic chest pain) and by observing infiltrates on chest radiography.[symptoma.com]
  • Ear In otitis externa (swimmer's ear), patients present with pain, pruritus, and ear discharge. The pain is worsened by traction on the pinna. Pseudomonas infection is a common cause of chronic otitis media.[emedicine.medscape.com]
  • Places where infection occurs -- and their signs -- may include: Ears: pain and discharge Skin: rash, which can include pimples filled with pus Eyes : pain, redness, swelling Bones or joints : joint pain and swelling; neck or back pain that lasts weeks[webmd.com]
  • […] around us. [6],[8] Signs and symptoms of disease General symptoms of bacterial infections have a quick onset such as shaking chills and fever ( 104 degrees F), shortness of breath, rapid breathing (more than 30 breaths/min.) and heartbeat( 20 bpm) chest pain[austincc.edu]
Chills
  • Symptoms of pneumonia include a productive cough, severe dyspnea, fever, chills, cyanosis, confusion, and signs of systemic inflammatory response. On physical examination, fever, cyanosis, rales, rhonchi, retractions, and hypoxia may be detected.[symptoma.com]
  • The patient presents with signs of severe systemic toxicity, and symptoms include fever, chills, dyspnea, cyanosis, confusion, and productive cough with green or yellow sputum. P. aeruginosa rarely causes disease in the healthy individual.[visualdx.com]
  • The genus Pseudomonas can be found almost everywhere: hospitals, nursing homes, and medical equipment; it’s all around us. [6],[8] Signs and symptoms of disease General symptoms of bacterial infections have a quick onset such as shaking chills and fever[austincc.edu]
  • Symptoms include: chills fever cough with or without sputum production difficulty breathing Skin When this bacterium infects the skin, it most often affects the hair follicles. This is called folliculitis.[healthline.com]
Malaise
  • Here, the authors report a case of community-acquired Pseudomonas pneumonia in a 26-year old healthy man who presented with 8-week history of malaise and cough.[ncbi.nlm.nih.gov]
  • Nonspecific symptoms include fever and malaise, with more specific symptoms depending on which cardiac valve is involved.[emedicine.medscape.com]
  • General symptoms include fever, murmur, and malaise, while more specific symptoms depends upon which valve is involved. Peripheral lesions and hemorrhages and an enlarged spleen can occur in addition to these specific symptoms.[microbewiki.kenyon.edu]
Rigor
  • As suggested above, rigorous studies with a strict microbiological diagnosis work-up and separating CAP and HCAP (which still needs a better definition) will allow us to definitively close the debate.[erj.ersjournals.com]
Cough
  • Here, the authors report a case of community-acquired Pseudomonas pneumonia in a 26-year old healthy man who presented with 8-week history of malaise and cough.[ncbi.nlm.nih.gov]
  • Community-acquired pneumonia is diagnosed by clinical presentation (e.g. fever, cough, pleuritic chest pain) and by observing infiltrates on chest radiography.[symptoma.com]
  • He presented with fevers, SOB and cough productive of thick purulent sputum and had a LUL infiltrate with sputum Cxs positive for MDR Pseudomonas aeruginosa.[pulmonaryroundtable.blogspot.com]
  • […] bacterial infections have a quick onset such as shaking chills and fever ( 104 degrees F), shortness of breath, rapid breathing (more than 30 breaths/min.) and heartbeat( 20 bpm) chest pain that occurs on the infected side only, muscle aches, a dry cough[austincc.edu]
Productive Cough
  • Symptoms of pneumonia include a productive cough, severe dyspnea, fever, chills, cyanosis, confusion, and signs of systemic inflammatory response. On physical examination, fever, cyanosis, rales, rhonchi, retractions, and hypoxia may be detected.[symptoma.com]
  • The patient presents with signs of severe systemic toxicity, and symptoms include fever, chills, dyspnea, cyanosis, confusion, and productive cough with green or yellow sputum. P. aeruginosa rarely causes disease in the healthy individual.[visualdx.com]
  • These patients may present with chronic productive cough, anorexia, weight loss, wheezing, and tachypnea. [6] Symptoms of pneumonia include fever, chills, severe dyspnea, cyanosis, productive cough, confusion, and other signs of a systemic inflammatory[emedicine.medscape.com]
  • She complained of severe chest pain with productive cough, supposedly without fever or chills. With the exception of smoking (at least 25 pack-years), there were no underlying risk factors.[ncbi.nlm.nih.gov]
  • P. aeruginosa pneumonia is marked by chills, fever, productive cough, difficult breathing, and blue-tinted skin.[medical-dictionary.thefreedictionary.com]
Sputum Production
  • He is stable but still has copious purulent sputum production and his sputum samples remain positive for Pseudomonas. His CT scan now shows extensive damage to the LUL (previously devitalized by xRt) : Susceptibility profile has remained the same.[pulmonaryroundtable.blogspot.com]
  • Symptoms include: chills fever cough with or without sputum production difficulty breathing Skin When this bacterium infects the skin, it most often affects the hair follicles. This is called folliculitis.[healthline.com]
  • production, coughing, and leukocytosis (white blood cell count 10,000/μL).[journals.plos.org]
Purulent Sputum
  • He presented with fevers, SOB and cough productive of thick purulent sputum and had a LUL infiltrate with sputum Cxs positive for MDR Pseudomonas aeruginosa.[pulmonaryroundtable.blogspot.com]
  • sputum In non-intubated patients confirmed microbiological diagnosis of P. aeruginosa serotype O11 HAP by endotracheal aspirate (ETA) and modified clinical pulmonary infection score (CPIS) higher than 6 points Patient is expected to survive longer than[clinicaltrials.gov]
  • Clinical manifestations are cough, purulent sputum, dyspnea, fever, confusion, and systemic toxicity. Chest radiograph usually shows multifocal airspace disease. Pseudomonal pneumonia mortality rate is high (70-80%).[ispub.com]
  • sputum, shortness of breath, and fever; with elevated infection parameters in blood lab tests; and with evidence of infiltrates in chest X-rays, according to the International Classification of Diseases (ICD J15.1).[journals.plos.org]
Tachypnea
  • This may cause them to have a chronic, phlegm-producing cough, loss of appetite, weight loss, wheezing and a fast breathing rate (tachypnea).[health.howstuffworks.com]
  • These patients may present with chronic productive cough, anorexia, weight loss, wheezing, and tachypnea. [6] Symptoms of pneumonia include fever, chills, severe dyspnea, cyanosis, productive cough, confusion, and other signs of a systemic inflammatory[emedicine.medscape.com]
Chest Pain
  • Community-acquired pneumonia is diagnosed by clinical presentation (e.g. fever, cough, pleuritic chest pain) and by observing infiltrates on chest radiography.[symptoma.com]
  • pain that occurs on the infected side only, muscle aches, a dry cough at first then sputum develops later, nausea, and vomiting.[5],[2] Microbial Virulence factors The toxicity of pseudomonads will result in the production of Toxin A.[austincc.edu]
  • To The Editor, A 33 year old woman was admitted to our hospital with fever, chest pain, and vomiting. Chest pain was pleuritic and was worse with inspiration. The patient was febrile for 6 days before evaluation.[ispub.com]
  • She complained of severe chest pain with productive cough, supposedly without fever or chills. With the exception of smoking (at least 25 pack-years), there were no underlying risk factors.[ncbi.nlm.nih.gov]
  • Pneumonia was defined as presence of: (1) new radiographic infiltration; (2) one or more of the following symptoms consistent with pneumonia (fever, cough, pleuritic chest pain, and dyspnea); and (3) isolation of P. aeruginosa from cultures of bronchoalveolar[bmcinfectdis.biomedcentral.com]
Uremia
  • A chest radiography with lateral and posteroanterior views may show focal or diffuse opacities but in immunosuppressed patients, especially those suffering from diabetes, uremia, neutropenia or alcoholism, the appearance of the infiltrates can be delayed[symptoma.com]

Workup

If pneumonia is suspected, blood gas analysis to assess the presence of hypoxia or hypercarbia should be performed and sputum and respiratory secretions have to be cultured. However, isolating Pseudomonas from tracheal secretions and sputum may reveal airway colonization. Sputum has a poor sensitivity and specificity for identifying the bacterial etiology of pneumonia, therefore in patients who are on mechanical ventilation quantitative cultures are obtained through bronchoalveolar lavage and specimen brushings.

Community-acquired pneumonia is diagnosed by clinical presentation (e.g. fever, cough, pleuritic chest pain) and by observing infiltrates on chest radiography. Sputum and blood cultures are rarely useful for outpatients and usually ordered for severely ill inpatients [7].

A chest radiography with lateral and posteroanterior views [8] may show focal or diffuse opacities but in immunosuppressed patients, especially those suffering from diabetes, uremia, neutropenia or alcoholism, the appearance of the infiltrates can be delayed. Other findings on the radiograph suggestive of pneumonia include parapneumonic effusions, air bronchograms, and the silhouette signs. P. aeruginosa has a predilection for lower lobes of the lungs. The involvement may be bilateral and extensive, or unilateral. Massive consolidation can occur but has a poor prognosis. Patchy bronchopneumonia, necrosis, abscess formation, and nodular infarcts are other possible findings. Complications of pneumonia such as atelectasis or lung abscesses may also be detected. In patients with existing structural lung diseases, the appearance of the signs of pneumonia on radiography will not be straightforward.

The use of computed tomography (CT) scan has increased in clinical practice, but its usefulness in assessing pneumonia has been questioned with various reports suggesting that CT scan should be limited to the following settings:

  • Examination of patients with neutropenia and fever of unknown origin (ultra-thin section CT scan).
  • To confirm the presence of pleural effusion.
  • Evaluating an abnormal, indistinct opacity detected on chest radiography.
  • Assessment of opacities on chest radiographs that appear patchy, linear/reticular, or have a ground-glass appearance.
Pulmonary Infiltrate
  • Differential Diagnosis & Pitfalls Pneumonia caused by other organisms such as: Streptococcus pneumoniae Haemophilus influenzae Mycoplasma pneumoniae Chlamydia pneumoniae Legionellosis Aspergillosis Coccidioidomycosis Pneumocystis jiroveci (carinii) Pulmonary[visualdx.com]
  • infiltrate, plus one of the three following criteria: a) fever greater than 38ºC, b) WBC greater than 10,000/mm3, or c) purulent sputum In non-intubated patients confirmed microbiological diagnosis of P. aeruginosa serotype O11 HAP by endotracheal aspirate[clinicaltrials.gov]
  • Figure 3 Figure 1c: Chest CT scan showing cavitating pulmonary infiltrates (arrow). The venous catheter was removed. A sonographic study of right upper extremity showed a thrombus in right internal jugular vein.[ispub.com]
  • All patients were diagnosed using conventional criteria of fever, new pulmonary infiltrate on imaging, leukocytosis, and growth of P. aeruginosa in a culture of respiratory secretions. No patient was bacteremic.[academic.oup.com]
  • Definitions Pneumonia was diagnosed when new, persistent pulmonary infiltrates not otherwise explained appeared on chest radiographs.[anesthesiology.pubs.asahq.org]
Atelectasis
  • Complications of pneumonia such as atelectasis or lung abscesses may also be detected. In patients with existing structural lung diseases, the appearance of the signs of pneumonia on radiography will not be straightforward.[symptoma.com]
  • In these individuals, the disease takes a chronic course beginning with mucous plugging and progressing to bronchiectasis, atelectasis, and fibrosis, ultimately leading to pulmonary hypertension and cor pulmonale.[visualdx.com]
Air Bronchogram
  • Other findings on the radiograph suggestive of pneumonia include parapneumonic effusions, air bronchograms, and the silhouette signs. P. aeruginosa has a predilection for lower lobes of the lungs.[symptoma.com]
Ground Glass Appearance
  • Assessment of opacities on chest radiographs that appear patchy, linear/reticular, or have a ground-glass appearance.[symptoma.com]
Hypercapnia
  • We previously reported that hypercapnia inhibits the expression of TNF and IL-6 and phagocytosis in macrophages in vitro.[ncbi.nlm.nih.gov]
Hypercapnia
  • We previously reported that hypercapnia inhibits the expression of TNF and IL-6 and phagocytosis in macrophages in vitro.[ncbi.nlm.nih.gov]
Blood Culture Positive
  • Patients with blood cultures positive for P. aeruginosa were identified from the computerized database of the clinical microbiology unit.[bmcinfectdis.biomedcentral.com]
Pseudomonas in the Sputum
  • The isolation of Pseudomonas aeruginosa from sputum in idiopathic bronchiectasis: an association with extensive disease and severe airflow obstruction. Am Rev Respir Dis 1993 ; 147 : A645 Roberts HR, Wells AU, Milne DG, et al.[erj.ersjournals.com]

Treatment

  • A dosing interval change to every four hours would have been appropriate in 28 of the 36 treatment courses (78%).(ABSTRACT TRUNCATED AT 250 WORDS).[ncbi.nlm.nih.gov]
  • The adequacy of initial antibiotic treatment is the only factor amenable to modification by medical intervention. Initial antibiotic treatment is frequently administered on an empirical basis.[erj.ersjournals.com]
  • The treatment of MDR P. aeruginosa pneumonia in critical patients is therefore becoming more of a challenge.[journals.plos.org]

Prognosis

  • Abstract Hypercapnia, an elevation of the level of carbon dioxide (CO2) in blood and tissues, is a marker of poor prognosis in chronic obstructive pulmonary disease and other pulmonary disorders.[ncbi.nlm.nih.gov]
  • Massive consolidation can occur but has a poor prognosis. Patchy bronchopneumonia, necrosis, abscess formation, and nodular infarcts are other possible findings. Complications of pneumonia such as atelectasis or lung abscesses may also be detected.[symptoma.com]
  • Community-acquired pneumonia due to Gram-negative bacteria and Pseudomonas aeruginosa : incidence, risk, and prognosis. Arch Intern Med 2002 ; 162 : 1849 –1858. Mandell LA, Wunderink RG, Anzueto A, et al.[erj.ersjournals.com]
  • Pseudomonas causes a wide spectrum of diseases; therefore, prognosis is varied.[emedicine.medscape.com]
  • Prognosis depends on the site of infection and underlying health of the individual patient.[patient.info]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • As an etiology of ventilator-associated pneumonia, P. aeruginosa has a high mortality rate compared to other organisms.[symptoma.com]
  • RECENT FINDINGS: The growing importance of P. aeruginosa as an etiologic agent of CAP, the occurrence of CAP in previously healthy adults and its high prevalence as an etiologic agent of late VAP are stressed in recent studies.[ncbi.nlm.nih.gov]
  • Abstract OBJECTIVE Ventilator-associated pneumonia (VAP) caused by Pseudomonas aeruginosa has been associated with higher case fatality rates than VAP caused by other bacterial etiologies. The causes of this excess mortality are unclear.[unboundmedicine.com]
  • Isolates in 33 Episodes of VAP in the Control Group Distribution of etiologies according to previous days of mechanical ventilation is shown in figures 1 and 2.[anesthesiology.pubs.asahq.org]

Epidemiology

  • The PFGE pattern of water isolate #78 was indistinguishable from that of the epidemiologically unrelated isolate #27.[ncbi.nlm.nih.gov]
  • In a very recent epidemiological study of a large series of hospitalised patients with CAP in Germany 1, the overall mortality was 14%, an apparently very high figure.[erj.ersjournals.com]
  • View Article PubMed Google Scholar Robins JM, Hernán MA, Brumback B: Marginal structural models and causal inference in epidemiology. Epidemiology. 2000, 11 (5): 550-560. 10.1097/00001648-200009000-00011.[bmcinfectdis.biomedcentral.com]
  • Driscoll JA, Brody SL, Kollef MH (2007) The epidemiology, pathogenesis and treatment of Pseudomonas aeruginosa infections. Drugs 67: 351-368.[omicsonline.org]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology P aeruginosa is an opportunistic pathogen. It rarely causes disease in healthy persons.[emedicine.medscape.com]

Prevention

  • It carries a high mortality and its prevention is, therefore, clearly important.[ncbi.nlm.nih.gov]
  • This knowledge will aid the development of improved strategies in prevention, management, and treatment of pneumonia.[grantome.com]
  • Even standard antibiotic regimens fail frequently and do not prevent the excess mortality. Since at least 38% of deaths can be directly attributable to the Pseudomonas pneumonia, improvement in therapy is needed.[unboundmedicine.com]

References

Article

  1. Fujitani S, Sun HY, Yu VL, Weingarten JA. Pneumonia due to Pseudomonas aeruginosa: part I: epidemiology, clinical diagnosis, and source. Chest. 2011;139(4):909-19.
  2. Chastre J, Fragon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165:867–903.
  3. Ruiz M, Ewig S, Torres A, et al. Severe community-acquired pneumonia: risk factors and follow up epidemiology. Am J Respir Crit Care Med 1999;160:923–939.
  4. Metaly JP, Schulz R, Li YH, et al. Influence of age on symptoms at presentation in patients with community-acquired pneumonia. Arch Intern Med. 1997;157(13):1453-9.
  5. Venkatesan P, Gladman J, Macfarlane JT, et al. A hospital study of community acquired pneumonia in the elderly. Thorax. 1990;45(4):254-8.
  6. Marrie TJ, Blanchard W. A comparison of nursing home-acquired pneumonia patients with patients with community-acquired pneumonia and nursing home patients without pneumonia. J Am Geriatr Soc. 1997;45(1):50-5.
  7. Watkins RR, Lemonovich TL. Diagnosis and management of community-acquired pneumonia in adults. Am Fam Physician. 2011;83(11):1299-306.
  8. Franquet T. Imaging of pneumonia: trends and algorithms. Eur Respir J. 2001;18(1):196-208.

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Last updated: 2019-07-11 21:02