Myths and Legends: Do Bronchial Valves Have a Role in the Management of Emphysema?

Emphysema and chronic obstructive pulmonary disease are highly prevalent disease states. Patients with severe emphysematous disease have been shown to benefit from lung volume reduction surgery, at the cost of increased perioperative mortality. Interest in minimally invasive bronchoscopic lung volume reduction has increased over the past 2 decades, with endobronchial valves (EBVs) being the most studied of these modalities. Currently, there are 2 such devices that are US Food and Drug Administration approved, Zephyr and Spiration. Here, we have reviewed the literature with regard to EBV placement, highlighting how previous trials have informed current indications for valve placement. This article also reviews the potential benefits of EBVs and the associated complications. Although bronchial valves have yielded promising results and are a potentially safer alternative to lung volume reduction surgery, further guidelines are needed to improve patient selection and procedure performance. Myth: In severe emphysema, surgical resection is the only option for lung volume reduction. …

Fatal Sepsis and Septic Shock Secondary to Aeromonas hydrophila Pneumonia: Report of a Case and Review of the Literature

Aeromonas hydrophila belongs to the family Aeromonadaceae and is ubiquitous in distribution. It can be widely isolated from environmental sources such as aquatic habitats, fish, and natural soils. Sepsis due to A. hydrophila infection usually occurs in immunocompromised hosts, but severe infection has been reported in apparently healthy individuals. We report a case of a 40-year-old immunocompetent woman who presented with pneumonia and septic shock secondary to A. hydrophila infection. Her clinical course was complicated by acute respiratory distress syndrome, metabolic acidosis, and multiorgan failure resulting in mortality. The isolate was susceptible to third-generation and fourth-generation cephalosporins, piperacillin-tazobactam, fluoroquinolones, and trimotheprim/sulfamethoxazole. Review of the literature for previous reports of infection with Aeromonas species infection in previously healthy individuals suggests that pneumonia and bacteremia due to A. hydrophila can be often fulminant and fatal. Early diagnosis and initiation of appropriate antibiotic therapy are crucial to reducing morbidity and mortality among patients infected with A. hydrophila. Physicians should be aware of the complications associated with A. hydrophila infection. …

Biomarkers in Pulmonary Infections

Pneumonia, either community acquired or hospital acquired, is the most frequent severe infection. Despite all new tools and developments, pneumonia is difficult to diagnose clinically, resulting from the lack of a “gold standard” method of diagnosis. This uncertainty is at least in part responsible for the overuse and misuse of antibiotics in the community and in the hospital, and this practice is probably a main drive for antibiotic resistance. Biomarkers may improve the clinical evaluation of a patient with a clinical suspicion of pneumonia. Among all the potential biomarkers, C-reactive protein and procalcitonin are the most extensively studied and used in clinical practice, and their role in triage, diagnosis, risk stratification, monitoring clinical course, and antibiotic stewardship has been extensively assessed. Both biomarkers showed that their use as an additional tool could be useful in the management of pneumonia. More recently “omics” technologies began to be used as new approaches in pneumonia. These promising technologies could in the near future improve the management of pneumonia. …

A Rare Cause of Spontaneous Pneumothorax

Pulmonary nodules detected at thoracic imaging studies are a frequent occurrence. The management of such nodules largely revolves around comparison with prior imaging studies to document stability, and, in the absence of such priors, serial imaging assessment, as determined by the patient’s age, smoking status, and nodule characteristics, including size, border characteristics, and nodule attenuation. Often such incidentally detected nodules, particularly when small, are ultimately shown to be benign through lack of growth at serial imaging assessment, and therefore a conservative approach to these nodules is generally favored. In contrast, larger solid nodules, particularly when >1 cm in size, or cavitation within a nodule, herald a potentially more aggressive, or even an “active,” process that frequently warrants definitive evaluation. Although the differential diagnosis of solid nodules and cavitary nodules is similar, the presence of cavitation often specifically raises the possibility of active infection or malignancy. In addition, the presence of cavitation within a nodular pulmonary opacity can be seen with a number of noninfectious, inflammatory lesions that are treated substantially differently than either infection or malignancy, and therefore definitive diagnosis is usually required in these circumstances. Finally, cavitary lung disorders can result in complications, including spontaneous pneumothorax, hemopneumothorax, pyothorax, and even bronchopleural fistula. …

Omadacycline is a Potential New Drug For Treatment in Moderate to Severe Community-acquired Pneumonia

Synopsis: Omadacycline is a new antibiotic, derived from the tetracycline class, which might fill the need for a novel antibiotic that is effective against the common bacterial organisms causing community-acquired pneumonia. This trial showed it to be noninferior to moxifloxacin. Source: Stets R, Popescu M, Gonong JR, et al. Omadacycline for community-acquired bacterial pneumonia. N Engl J Med. 2019;380:517–527. …

1 2 3 9