Abstract
Pneumonia is the most common acute life-threatening infection in the USA, affecting >1% of the population each year and causing over 1.25 million hospitalizations. The incidence of pneumonia begins to increase after and above 65 years of age. About 3% of people over the age of 65 in the USA are likely to develop pneumonia every year, of which almost half will be hospitalized, resulting in more than 1.5 million hospitalizations per year [Sprung et al. Can J Anaeth. 53:1244–1257 (2006)]. About 7% of patients hospitalized with pneumonia die within 7 days and another 7% die within the next 30 days. Older adults make up the majority of patients treated in the healthcare system, largely due to their increased burden of chronic disease and their marked vulnerability such as functional and cognitive decline, falls, delirium and frailty. Pneumonia is one of the most common diseases in the elderly. Age-related changes in lung function cause a decrease in respiratory reserve during acute disease. Changes occur in pulmonary vascularization by increasing pulmonary vascular stiffness, vascular pressures and vascular resistance. Invasion by bacteria, viruses and other pathogens evokes systemic inflammation in response to the active immune system. Mechanisms of innate immunity include physical barriers and phagocytic cells such as neutrophils and macrophages, which destroy pathogenic bacteria. The elimination of bacteria occurs through the activation of phagocytes locally in the lung caused by the innate defense mechanism. Structural changes occur with aging; for example, there is a decrease in the beat and eyelash numbers, which reduces the clearance of debris and pathogens, with a consequent increase in the chances of infection.
During the COVID pandemic, differential diagnosis is crucial for elderly patients. Much viral pneumonia with interstitial radiological patterns can be due to many different viruses (influenza A and B pneumonia, parainfluenza and coronavirus, mycoplasma) and many clinical and radiological models are actually mixed (bacterial and viral pneumonia). In this chapter, we discuss the differential diagnosis of elderly pneumonia.
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References
Sprung J, Gajic O, Warner DO. Review article: age-related alterations in respiratory functionanaesthetic considerations. Can J Anaeth. 2006;53:1244–57.
Nagaratnam N, Nagaratnam K, Cheuk G. Diseases in the elderly—age-related changes and pathophysiology. Cham, Switzerland: Springer International Publishing; 2016.
Scheld WM, Mandell GI. Nosocomial pneumonia: pathogenesis and recent advances in diagnosis and therapy. Rev Infect Dis. 1991;13(Suppl 9):S743–51.
Emori TG, Banerjee SN, Culver DH, Gaynes RP, Horan TC, Edwards JR, et al. Nosocomial infections in the elderly patients in the United States. 1986–1990. Am J Med. 1991;91(S3B):289S–93S.
Schaaf B, Liebau C, Kurowski V, Droemann D, Dalhoff CK. Hospital acquired pneumonia with high-risk bacteria is associated with increased pulmonary matrix metalloproteinase activity. BMC Pulm Med. 2008;8:12.
Goldman-Cecil: Medicine 26th Ediction Elsevier 2020.
Ramirez JA, Wiemken TL, Peyrani P, et al. Adults hospitalized with pneumonia in the United States: incidence, epidemiology, and mortality. Clin Infect Dis. 2017;65:1806–12.
Torres A, Cillóniz C. Clinical management of bacterial pneumonia. Cham, Switzerland: Springer International Publishing; 2015. p. 1.
Berk SL. Bacterial pneumonia in the elderly: the observations of Sir William Osler in retrospect. J Am Geriatr Soc. 1984;32(9):683–5.
Henyg O, Keith S. Kaye Bacterial pneumoniae in older adult. Infect Dis Clin N Am. 2017;31:689–714.
CDC 02/06/2020: Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease COVID-19.
Gattinoni L, Chiumello D, Caironi P, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med. 2020;46:1099–102. https://doi.org/10.1007/s00134-020-06033-2.
Ziehr DR, Alladina J, Petri CR, et al. Respiratory pathophysiology of mechanically ventilated patients with COVID-19: a cohort study. Am J Respir Crit Care Med. 2020; https://doi.org/10.1164/rccm.202004-1163LE.
Brown SM, Jones BE, Jephson AR, Dean NC. Validation of the Infectious Disease Society of America/American Thoracic Society 2007 guidelines for severe community-acquired pneumonia. Crit Care Med. 2009;37(12):3010–6.
Fang WF, Yang KY, Wu CL, Yu CJ, Chen CW, Tu CY, et al. Application and comparison of scoring indices to predict outcomes in patients with healthcare-associated pneumonia. Crit Care. 2011;15(1):R32.
Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336(4):243–50.
Cillóniz C, Ewig S, Polverino E, Marcos MA, Esquinas C, Gabarrús A, et al. Microbial aetiology of community-acquired pneumonia and its relation to severity. Thorax. 2011;66(4):340–6.
Song J-H, et al. Treatment guidelines for community-acquired pneumonia in Korea: an evidence-based approach to appropriate antimicrobial therapy. Infect Chemother. 2009;41(3):133–53. https://doi.org/10.3947/ic.2009.41.3.133.
Sligl WI, Majumdar SR, Marrie TJ. Triaging severe pneumonia: what is the “score” on prediction rules? Crit Care Med. 2009;37(12):3166–8.
Liang W, Liang H, Ou L, et al. Development and validation of a clinical risk score to predict the occurrence of critical illness in hospitalized patients with COVID-19. JAMA Intern Med. 2020;2020:e202033. https://doi.org/10.1001/jamainternmed.2020.2033.
Wootton D, Feldman C. The diagnosis of pneumonia requires a chest radiograph (X-ray)—yes, no or sometimes? Pneumonia. 2014;5:1–7. https://doi.org/10.15172/pneu.2014.5/464.
Henig O, Kaye KS. Bacterial pneumonia in older adults. Infect Dis Clin N Am. 2017;31(4):689–713. https://doi.org/10.1016/j.idc.2017.07.015.
Chavez MA, Shams N, Ellington LE, et al. Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. Respir Res. 2014;15:50.
Seo H, Cha S-I, Shin K-M, Lim J-K, Yoo S-S, Lee S-Y, Lee J, Kim C-H, Park J-Y. Community-acquired pneumonia with negative chest radiography findings: clinical and radiological features. Respiration. 2019;97:508–17. https://doi.org/10.1159/000495068.
Ticinesi A, Lauretani F, Nouvenne A, et al. Lung ultrasound and chest X-ray for detecting pneumonia in an acute geriatric ward. Medicine. 2016;95(27):e4153.
Gadsby NJ, Russell CD, McHugh MP, et al. Comprehensive molecular testing for respiratory pathogens in community-acquired pneumonia. Clin Infect Dis. 2016;62:817–23.
Jain S, Self WH, Wunderink RG, et al. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015;373:415–27.
Oyarzun GM. Pulmonary function in aging. Rev Med Chil. 2009;137:411–8; (abstract)
Fry AM, Shay DK, Holman RC, et al. Trends in hospitalizations for pneumonia among persons aged 65 years or older in the United States, 1988-2002. JAMA. 2005;294(21):2712–9.
Carsana L, Sonzogni A, Nasr A, Rossi RS, Pellegrinelli A, Zerbi P, Rech R, Colombo R, Antinori S, Corbellino M, Galli M, Catena E, Tosoni A, Gianatti A, Nebuloni M. Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study. Lancet Infect Dis. 2020; https://doi.org/10.1016/S1473-3099(20)30434-5.
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De Blasio, A., Chioni, L., Adorni, G. (2020). Differential Diagnosis of Types of Pneumonia in the Elderly. In: Vargas, N., Esquinas, A.M. (eds) Covid-19 Airway Management and Ventilation Strategy for Critically Ill Older Patients. Springer, Cham. https://doi.org/10.1007/978-3-030-55621-1_5
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