Community-acquired pneumonia remains a major cause of morbidity and mortality globally. Streptococcus pneumoniae is recognized the main pathogen related to pneumonia in all site of care. However, recent advances in molecular techniques have led to recognized that respiratory viruses are a common and important cause of severe CAP. Also, in the last 10 years new respiratory viruses are recognized as potential infectious agents in pneumonia. Recent studies show that in approximately 10 to 40% of pneumonia cases are involved viral pathogens being influenza virus the most common respiratory virus. A better knowledge of the role of respiratory viruses especially in cases of severe pneumonia may lead to better management of this population. This review aimed to describe the main respiratory viruses involved in severe pneumonia, specially focus in the clinical presentation, diagnosis, therapy and outcomes.

Community-acquired pneumonia (CAP) is the most frequent infectious disease, responsible for a great morbidity and mortality worldwide. It is known that poor outcome in CAP patients is not only directly related to pneumonia but also to comorbidities both during hospitalization and long term after discharge. Evidences show a high correlation between acute respiratory infections and increased risk of cardiovascular events (CVEs), such as acute myocardial infarction, arrhythmias, congestive heart failure, and stroke. The excessive systemic inflammatory response is responsible for hypoperfusion and activation of cytokines causing endothelial dysfunction, pro-coagulant effects, and atheroma instability. An established diagnostic tool to identify high-risk patients is not yet available, but cardiovascular biomarkers seem to be more effective than inflammatory molecules. Early identification of patients at higher risk for CVEs is mandatory to treat them effectively with prophylaxis medications, to establish adequate clinical surveillance and prevention with vaccinations. The present article reviews the epidemiology, pathophysiology, clinical presentation, risk factors, diagnosis, outcomes, and prevention of CVEs in patients hospitalized for CAP.

Allergic bronchopulmonary aspergillosis (ABPA) is a complicated inflammatory condition characterized by an allergic response to the fungus Aspergillus colonizing in the bronchus. It occurs most frequently in patients with asthma or cystic fibrosis. Oral corticosteroids are the standard therapy for ABPA. Antifungal drugs can clear the fungi in the airway, reduce the body's antigen load, decrease the body's allergic reaction, and reduce corticosteroid requirement. Total serum IgE should be used as an index for efficacy assessment during treatment and follow-up.

Bronchiectasis is a common progressive respiratory disease characterized by exacerbations and recurrent chest infections with high morbidity and reduced quality of life. Cole's vicious cycle model explains the evolution of this disease, in which an initial insult in the bronchi, often on a background of impaired mucociliary clearance or bactericidal activity, results in persistence of microbes in the sinobronchial tree and microbial colonization. Microbial overgrowth then causes infection and chronic inflammation, resulting in tissue damage, and impaired mucociliary motility. Subsequent antimicrobial treatments, microbiota interactions, and hypermutation can favor the development of resistance and the appearance of multidrug-resistant (MDR) bacteria. In this paper, we summarize the current knowledge on how bacteria become MDR in noncystic fibrosis bronchiectasis, and which are the most common bacterial pathogens, excluding Mycobacteria.

Non-tuberculous mycobacteria (NTM) are ubiquitous microorganisms in our environment. Although data are not truthful, we can say that we are experiencing an increase in the incidence-prevalence of infections by these microorganisms, especially in vulnerable population such as those with certain respiratory diseases, such as bronchiectasis (BQ). In all species NTM, the most studied is Mycobacterium avium complex, although the M abscessus is considered the most serious species in cystic fibrosis (CF) and M. xenopi in non-CF BQ. They described five clinical forms, the most frequent nodular/bronchiectasis and severe disseminated. The diagnosis of NTM lung disease in BQ is complicated, and continues to rely on three variables: clinical, radiological and microbiological. Given this difficulty, many suggest an observation period before starting a treatment, not always well tolerated and with side effects. Although morbidity and mortality is not high, they have been described risk factors that make it essential early treatment to avoid further serious complications.

Exacerbations are significant events in the course of bronchiectasis. Exacerbations are associated with accelerated lung function decline and deterioration in quality of life (QoL). Prevention of exacerbations is therefore one of the key objectives of management of bronchiectasis. A few treatments have been proven to reduce the risk of exacerbations, but these include the treatment of underlying causes of bronchiectasis and the use of prophylactic antibiotic therapies (macrolides and inhaled antibiotics). Nonantibiotic therapies, such as airway clearance and pulmonary rehabilitation, also play an important role in the prevention of exacerbations. Acute exacerbations are treated with antibiotics directed against the known bronchiectasis pathogens and guided by previous sputum culture results. This emphasizes the importance of screening sputum cultures in stable patients. Assessment of severity is used to determine whether patients should be treated at home or in hospital. Supportive therapy for exacerbations should include airway clearance alongside oxygen, hydration, and treatment of bronchospasm as required. Bronchiectasis is a rapidly developing field and new therapies, both for the prevention of exacerbations and the treatment of acute exacerbations, are currently being developed.

There is a higher prevalence of community-acquired pneumonia (CAP) worldwide. The stratification of the severity and prognosis of CAP is a vital feature as it is one of the most common causes of mortality among other infectious diseases in the developed countries. The mortality rate of patients with CAP depends on the severity of the disease, treatment failure along with the requirement of hospitalization and/or Intensive Care Unit (ICU) management which is quite cost-effective. To improve the outcomes in the management of CAP, there has recently been a significant attention paid to focus on the use and implication of evidence-based scoring systems and biological markers to justify hospital admission in either acute medical settings or ICU, also to classify the disease severity which will help in predicting the mortality rate. We have reviewed the significance of established and newly developed clinical scores, biological markers, and cytokines whether used alone or in conjunction with the clinical severity scores to assess the severity of the disease, prediction of early or late treatment failure, justify the acute in-hospital or ICU admission, and for the identification of short- and long-term mortality. In conclusion, the incorporation of the biological markers in the prognostic scales of the clinical scoring systems may improve the mortality prediction value of patients with CAP requiring acute hospitalization or ICU care and further studies at a larger scale are needed to corroborate the additive value of biological markers.

An increasing prevalence of pneumonia caused by drug-resistant pathogens (DRPs) has been identifi ed. The 2005 American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) guidelines proposed the health care-associated pneumonia (HCAP) model in order to identify an increased risk of DRPs in patients coming from the community. These patients are known to have a worse prognosis, mostly due to poor functional status and treatment restrictions. New useful scores have been developed to help physicians in predicting DRPs. This manuscript is a review of currently published literature concerning the impact of CAP caused by DRPs and the different predictive models available.

Community-acquired pneumonia (CAP) is a frequent infectious disease that can be usually treated in an ambulatory setting. A small percentage of these cases require hospitalization and yet it is the leading infectious cause of hospitalization and death in some countries. A number of these infections is caused by gram-negative bacteria (GNB), which have repeatedly been found to bear an adverse prognostic potential. Its incidence is variable (0-9%) and some species carry a special pathogenicity. Enterobacteriaceae in these studies were more commonly isolated than P. aeruginosa while Acinetobacter spp. and B. cepacia were only occasionally described. The present review has the aim to update the current knowledge about the etiology, classifi cation, antimicrobial resistance, diagnosis, and therapy in CAP due to GNB.

Intravenous drug use (IDU), initially confined to developed countries, specifically the western countries is no more bound by boundaries. In last few decades, the prevalence has been increased several fold and is a matter of serious concern. IDUs indulge in high-risk activities like sharing of the needle and unprotected sexual activities, which make them more vulnerable to acquired human immunodeficiency virus (HIV) infection (acquired immune deficiency syndrome [AIDS]). They silently spread the infection in the community (other IDUs, spouses and sexual partners). There is an increasing trend of HIV infection/AIDS among intravenous drug abusers across the world including India being no exception. The article highlights the global epidemiological data, specific focus of India.

In its strongest resurgence since the pandemic of 2009, the influenza type A virus, known as H1N1, has broken out in different parts of India with deaths surpassing 1000 mark and number of affected cases exceeding 18,000 by the end of February 2015. Swine influenza spreads from person to person, either by inhaling the virus or by touching surfaces contaminated with the virus, then touching the mouth or nose. Symptoms occurring in infected human by H1N1 are like any other flu symptoms. Treatment is largely supportive and consists of bed rest, increased fluid consumption, cough suppressants, antipyretics and analgesics for fever and myalgias. Management largely includes the potential use of antiviral agents for patients presenting with illness due to influenza virus infection. If the illness is known or suspected to be due to a zoonotic influenza A virus, oseltamivir or zanamivir are treatment options. For known or suspected infection with avian influenza H5N1 virus, antiviral treatment should follow the World Health Organization (WHO) rapid advice guidelines on pharmacological management of humans infected with highly pathogenic avian influenza A (H5N1) virus. WHO also recommends vaccination of the high-risk group with seasonal influenza vaccine. Vaccination is recommended for health care workers working in close proximity to influenza patients are at higher risk of acquiring the disease. Since swine flu can directly be transmitted from one person to another through air droplets, people who fail to follow proper hygiene, especially in crowded places are at a high risk of contracting the virus. Proper preventive and control measures thus must be ensured. We have only limited treatment options, so rational use of the antiviral agent is very essential to avoid resistance and future complications. Health education and awareness among citizens should be transferred by proper mechanism.

In the last few years, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) has become the new gold standard method for the identification of microorganisms. Nevertheless, other useful applications of mass spectrometry have recently been demonstrated including the detection of resistance mechanisms. The MALDI-TOF-MS hydrolysis assay allows rapid detection of β-lactamase activity with results available within a few hours. Rapid detection of β-lactamases is important since β-lactam antibiotics remains as the mainstay of the treatment of several community-acquired and nosocomial infections, and a steady increase has been observed of resistant microorganisms associated with the production of extended spectrum β-lactamases (ESBLs) and carbapenemases. Several studies have reported the high sensitivity and specificity of the MALDI-TOF-MS antibiotic hydrolysis assay for the detection of ESBLs - or carbapenemase-producing Gram-negative bacilli. In addition, this technique can be performed directly from positive blood culture, significantly shortening the time of resistance detection. However, the standardization of assay conditions as well as automatic analysis of the spectra obtained is required. The aim of this review was to summarize the currently available data regarding the accuracy of the detection of β-lactamase activity using the MALDI-TOF-MS antibiotic hydrolysis assay.

Strong evidence supports the use of noninvasive ventilation (NIV) in acute respiratory failure (ARF) to prevent endotracheal intubation (ETI) in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD), cardiogenic pulmonary edema, and immunocompromised patients. However, weaker evidence supports NIV used in acute respiratory distress syndrome (ARDS) and ARF due to community-acquired pneumonia (CAP) in immunocompetent patients owing to high rates of treatment failure. In all patients, NIV should be applied under close monitoring for signs of treatment failure and, in such case, ETI should be promptly available. A trained team, at an appropriate location, with careful patient selection and optimal choice of devices can optimize NIV outcome. In this short review we examine past and more recent literature regarding the use of NIV in ARF due to CAP, discussing the application of both continuous positive airway pressure (CPAP) and pressure support ventilation (PSV).

Ophthalmic infections of fungal origin, namely mycotic keratitis, mycoticendophthalmitis, etc., are commonly encountered in the tropical and sub-tropical countries including India. Mycotic keratitis, in particular, presents an important ophthalmic problem causing visual disability due to its protracted course and unfavorable responses. Determination of various host and environmental factors that put an individual at risk for development of fungal infections in the eye may reduce the time to their diagnosis. Even though Aspergillus and Fusarium are the most common species causing keratitis, pigmented dematiaceous fungi remain an important cause of mycotic keratitis. Majority of fungal keratitis responds to medical therapy if diagnosed on time and treatment started immediately. Failure of medical therapy may be due to infection of the cornea by certain pathogens or late presentation, which requires surgical treatment in conjunction with anti-fungal therapy post-operative. We, therefore, searched for literatures using the keywords "pigmented fungi, pheohyphomycosis, keratitis, ophthalmology" through GoogleScholar and reviewed the microbiology of pheohyphomycosis of the eye and its treatment in the light of improved culture and diagnostic methods.

Community-acquired pneumonia (CAP) remains an important cause of morbidity and mortality in developed countries. The disease is one of the top 10 causes of death and up to the present time, standard aggressive medical care has not resulted in a decrease in mortality. Knowledge of risk factors for CAP is essential to the design of preventive measures to reduce its incidence. Preventive strategies promoting effective vaccines or identifying and acting on modifiable risk factors are of paramount importance in reducing CAP-related death. Most studies have been performed in patients referred for inpatient care or in CAP cases in which a specific pathogen has been identified, but data from population-based studies are scarcer. We present a review of the main risk factors for CAP in adults, classified in the following categories: (a) Comorbidities and their treatments, (b) demographic and socioeconomic factors, (c) lifestyle factors and (d) environmental factors. We conclude with some brief recommendations on preventive measures and vaccination.

The presence of chronic infections in patients with respiratory diseases has led to an increased interest in inhaled antibiotics. Their utility has been demonstrated in cystic fibrosis (CF) and extended their use to chronic obstructive pulmonary disease and non-CF bronchiectasis (BE). We have seen a development of new inhaled formulations and nebulizers in the last years. The main objective is to reduce the airway bacterial load, symptoms and the rate and severity of exacerbations. Actual BE guidelines recommend inhaled antibiotics when a patient has 3 or more exacerbations per year. Recent meta-analysis shows an overall benefit for BE patients with inhaled antibiotics. Nowadays, there are different nebulizer systems such as ultrasonic nebulization, "jet" nebulizer, and vibrating mesh system. In addition, there are several antibiotic formulations for nebulization and some dry powder formulations. We review the current evidence available for inhaled antibiotics in BE patients and the systems designed for the inhalation of antibiotics.

Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. "Severe CAP'' (sCAP) identifies a group of patients who have severe disease and require Intensive Care Unit admission. Recommendations for antibiotic treatment for sCAP are based on illness severity, frequency of specific pathogens and local microbial resistance patterns. The challenges to patient management include the emergence of the high prevalence of multidrug-resistant in CAP, mainly from institutionalizing patients. A new approach is the evaluation of biomarkers as C-reactive protein, procalcitonin on the diagnosis, prognosis and therapy duration of sCAP with promising results . Implementation of guidelines for CAP treatment should be emphasized in order to increase survival. The benefits of steroid use in patients with severe pneumonia have not been proven yet by current literature.

Atypical pathogen, especially Mycoplasma pneumoniae is a common and important pathogen of community-acquired pneumonia. Physicians should pay more attention on them. Compared with bacteria, the clinical treatment of atypical pathogens is different, as beta-lactams are not effective for atypical pneumonia. Therefore, laboratory diagnostic methods and clinical biology research is particularly important for the diagnosis and treatment of atypical pneumonia. In order to provide more theoretical basis for clinical diagnosis of atypical pathogens infection, we performed a review of the research progress of prevalence, laboratory testing of atypical pathogens related infections.

The novel mechanism of action of macrolides was discovered when a significant improvement in the survival of patients with diffuse panbronchiolitis (DPB) receiving low dose of erythromycin was observed, and when their beneficial effect was found to be independent of their anti-microbial activity. Macrolides that are members of the 14- and 15-ring groups show beneficial effects against DPB but not those of the 16-ring groups. We could recognize these effects of macrolides because their administration was associated with reduced inflammatory response in chronic airway diseases including upper- and lower-respiratory tract infections. The anti-inflammatory action of macrolides during infections by bacteria and virus with high virulence has been recently the focus of several studies. Thus, this interesting anti-inflammatory effect of macrolide is currently being assessed not only in the rare condition of DPB but also in common diseases such as viral airway infection. In this review, we will summarize the use of macrolides in common and rare diseases during the past 25 years.