Community acquired pneumonia

 

 “Acute bronchitis (according to the Mayo Clinic website) often develops from a cold or other respiratory infection. People who have bronchitis often cough up thickened mucus, which can be discolored. The illness usually improves within a week to 10 days without lasting effects, although the cough may linger for weeks.”  The condition “is usually caused by viruses, typically the same viruses that cause colds and flu (influenza). Many different viruses — all of which are very contagious — can cause acute bronchitis. Antibiotics don't kill viruses, so this type of medication isn't useful in most cases of bronchitis.”   

When I practiced medicine I believed people should not start antibiotics until or unless they ran a fever or their sputum turned thick or yellow.  Some of my non medical friends thought I was wrong and started taking a five day course of the antibiotic Azithromycin (a Z pack) when the first developed symptoms. They apparently thought taking antibiotics helped them avoid developing pneumonia.(1)

        “Community-acquired pneumonia is most commonly caused by Streptococcus pneumoniae, Mycoplasma pneumoniae, or Chlamydia pneumonia and is the seventh leading cause of death in the United States. (According to Cody Cotner and a few other Harvard doctors.) 

In the era before antibiotics, most doctors thought streptococcus pneumoniae (the pneumococcus) was the cause of 95% of all cases of pneumonia. Currently the bacteria accounts for up to 15% of pneumonia cases in the United States and 27% of cases worldwide today. (2)


       The second leading cause of community acquired pneumonia—so called walking pneumonia--is caused by mycoplasma pneumonia, a very small bacterium that lacks a cell wall.  Once called the Eton agent and thought to be a virus, this bacterium fuses with host cells and survives inside the cell. As a result it can evade host immune system detection, resist antibiotics, and cross mucosal barriers. 

“The cytotoxic effects of M. pneumoniae infections translate into common symptoms like coughing and lung irritation that may persist for months after infection has subsided. Local inflammation and hyper-responsiveness induced small peptides—cytokines-- has been associated with chronic conditions such as bronchial asthma and has also been linked to progression of symptoms in individuals with cystic fibrosis and COPD.”

Penicillin like antibiotics kill by inhibiting bacterial cell wall synthesis and not surprising, don’t cure infections caused by this bug.  ”

Mycoplasma Infections are usually treated with oral antibiotics that inhibit protein biosynthesis like azithromycin or clarithromycin.  Alternatively doxycycline and respiratory flurquinoloes like levofloxacin or moxifloxacin often work. Some of these drugs have an undesirable side effect profile in children.

Myocoplasma that are resistant to azithromycin like drugs have been increasing worldwide.  Resistance in the 2020s has been highest in Asia, as high as 100%, while rates in the United States have varied from 3.5% to 13%. (3)

The third leading bacteria that causes community acquired pneumonia is Chlamydia pneumonia, a small, gram-negative bacterium (0.2 to 1 micrometer) that undergoes several transformations during its life cycle.  The bug is an obligate intracellular bacterium and exists as an elementary body (EB) between hosts. The EB is not biologically active, but is resistant to environmental stresses and can survive outside a host for a limited time. It travels from an infected person to the lungs of an uninfected person in small droplets.  The majority of the population becomes exposed to this pathogen throughout their lifetime. It has a 50% antibody prevalence by 20 years of age and 80% by the age of 60 to 70 years, suggesting that the infection is usually asymptomatic, and people are infected and reinfected throughout their lives.  C. pneumoniae infection can be widespread in the form of an endemic or epidemic and is known to be a cause of community-acquired pneumonia in up to 20% of the cases. In western countries, the age group of 5 to 15 years has the highest rate of new infections.  Most infections are mild, with a characteristic subacute onset, and may be difficult to distinguish from other forms of community-acquired pneumonia (CAP) or viral infections.  They rarely can have a severe course leading to respiratory failure and death. Infection may take an acute or chronic course, maybe be recurrent (reinfection), or exist in a carrier state. 

Pneumonia usually starts with nonspecific flu-like symptoms of pharyngitis, laryngitis, or sinusitis during which the patients have symptoms such as fever, hoarseness, sore throat, and headache. Mild pneumonia follows in the next 1–4 weeks.  It is characterized by cough persisting for several weeks. Other symptoms are shortness of breath and muscle pain in the chest due to coughing. Nonspecific symptoms such as anorexia, nausea, gastrointestinal disturbance, and body aches are usually present as well. The disease can be severe.

Centers for Disease Control and Prevention (CDC) recommends azithromycin and doxycycline as first-line drugs for the treatment of chlamydial infections; alternatively, levofloxacin, erythromycin, and ofloxacin are considered antibiotics of choice are different for different species. (4)

1. https://www.mayoclinic.org/diseases-conditions/bronchitis/symptoms-causes/syc-2035552266

2.  https://www.ncbi.nlm.nih.gov/books/NBK470537

 November 6, 2024  N Engl J Med 2024;391:1735-1741.

3.  https://en.wikipedia.org/wiki/Mycoplasma_pneumonia

  

4. https://www.ncbi.nlm.nih.gov/books/NBK560874/

 

 

Comments

Post a Comment

Popular posts from this blog

what is targeted chemotherapy

  According to AI There are about 3 billion pairs of nucleotides.   Most of the nucleotides are involved in turning a fertilized cell into a being.   2 percent of the nucleotides are genes and they direct the cells to make various proteins.    There are about 20,000 protein coding genes and each gene contains the instructions for making a single protein.   20 to 30 percent of the proteins the cell makes perform a function in the cell membrane.     One type of membrane protein is called a receptor tyrosine kinase (RTK).   it penetrates the membrane and sticks out inside and outside the cell.   When the outside of this protein is activated—a signal travels through the protein and the inside portion of the protein directs a cell to act a certain way.   It, for example, can tell a cell to grow, divide, die etc.   the outside extension of each receptor has a pocket.   When the right molecule is inserted into the poc...
Read more

?? THE SNAKE ANTIVENOM OF THE FUTURE.

  An article in the October issue Science described a new drug that could save the lives of up to 100,000 Africans.   It’s 3 years away from trials in humans but if it works—who knows.   The article claims that each year about 100,000 Africans are killed by venomous snakes and the current antivenom isn’t very effective for a number of reasons.   “This new kind of antivenom has proved protective only in mice so far. But   “It’s a potential game changer if all goes well.” To make their antivenum Laustsen-Kiel and colleagues injected mixtures of venoms from 18 African snakes into llamas and alpacas and the animals made antibodies. Their antibodies are smaller than those of horses and humans and have only one protein chain, instead of two, on each arm of the Y-shaped molecule. Each arm, dubbed a nanobody, can be separated from its base while remaining able to bind a target molecule, such as a toxin . The isolated arms lack the animal-specific sections th...
Read more

MALARIA

  ACCORDING TO THE WORLD HEALTH ORGANIZATION Globally in 2023, there were an estimated 263 million malaria cases and 597 000 malaria deaths in 83 countries. The WHO African Region carries a disproportionately high share of the global malaria burden. In 2023, the WHO African Region was home to 94% of malaria cases (246 million) and 95% (569 000) of malaria deaths. Children under 5 accounted for about 76% of all malaria deaths in the Region. Malaria  is a  mosquito-borne infectious disease     people who are bitten by infected mosquitoes often develop a “ fever ,  fatigue ,  vomiting , and  headaches , and in severe cases, it can cause  jaundice ,  seizures ,  coma , or  death . [1] [9]  Symptoms usually begin 10 to 15 days after being bitten   The current therapy is Artemisinin.   It’s discovery led to a Nobel Prize in 2015. The World Health Organization began to recommend ACTs as the front-line treatment for ma...
Read more