Pneumonia INDEX

Several scoring systems are available for assessing the severity of the pneumonia the Pneumonia Severity Index (PSI), Confusion, Urea, Respiratory Rate, and Blood Pressure (CURB), and CURB-65 (those 65 years and older).9,24 Some... 

The obvious symptom of starvation is a loss of weight, which is most easily assessed by a decrease in the body mass index (BMI). Indeed, it is an excellent predictor of death from starvation. A value of BMI below about 13 in men and about 12 in women is not compatible with life. These values coincide with a loss of about 50% of lean body mass. The major causes of death from malnutrition in developed countries are pneumonia, other infections or heart failure. 

Index functional status 30 d after stroke. The results showed that only the severity of neurological deficit predicted greater 30-d mortality in these patients. Patients with hyperthermia on the first day of hospitalization had increased mortality and worse functional status at 30 d, but increased temperature was not an independent predictor of mortality 30 d after PICH. In a study to assess typical early onset complications following ischemic stroke, Weimar et al. (5) looked at a cohort of 3866 patients from 14 neurology departments with an acute stroke unit. In the first week following admission, increased intracranial pressure (ICP) and recurrent cerebral ischemia were the most frequent complications, along with fever, severe hypertension, and pneumonia. Similar concerns are also found in cardiac surgery patients in whom perioperative stroke occurred (6). 

As with anthrax, early diagnosis of plague is critical and requires a high index of suspicion. In the United States, if only a small number of cases occur, physicians may overlook pneumonic plague for a couple of reasons. First, plague pneumonia... 

Given its rarity, physicians and hospital laboratorians have a low index of suspicion for tularemia infection. Because of the nonspecific symptoms and absence of radiographic findings, physicians and public health authorities would have difficulty distinguishing between a terrorist attack involving tularemia and a natural outbreak of community acquired infection, especially influenza and some atypical pneumonias (43). Several epidemiologic clues that might indicate an intentional cause would include (43) ... 

Agent Index A317 Class Index C24 Melioidosis Pseudomonas pseudomalle Type Bacteria Presents a range of manifestations from asymptomatic involvement of the lungs to necrotizing pneumonia and/or fatal blood poisoning. May simulate typhoid fever or tuberculosis. Routes Incubation 2 days to Inhalation years Ingestion Mortality Rate — Abraded Skin Reservoir Soils, Water, Rodents, Secondary Hazards Farm animals Body Fluids Direct Person-to-Person Transmission does not occur. 

Chlamydia pneumoniae (CP) is the first bacteria reported to be associated with increased body mass index (BMI) in humans. Experimental inoculation of animals with CP to study the effect on body weight has not been reported. 

Dart, A.M., Martin, J.L., and Kay, S. 2002. Association between past infection with Chlamydia pneumoniae and body mass index, low-density lipoprotein particle size and fasting insulin. Int. J. Obes. Relat. Metab. Disord. 26, 464-468. 

A 56-year-old patient with rheumatoid arthritis, who was started on INH chemoprophylaxis for a positive tuberculin skin test, developed interstitial pneumonia 2 weeks after the start of INH. The result of Drug Lymphocyte Stimulation Test (DLST) for INH was positive with the peripheral blood lymphocytes (stimulation index 208%). Trans-Bronchial Lung Biopsy specimens showed cellular no specific interstitial pneumonia pattern... 

Joshi N, Localio AR, Hamory BH. A predictive risk index for nosocomial pneumonia in the intensive care unit. Am J Med 1992 93 135-142. 

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