Thank you to
team 5 for bringing the case and to Dr. Andrea Page for hosting.
Today, we
discussed a case of an elderly man from a long-term care facility who presented
with shortness of breath. The
differential diagnosis was quite wide, and we had the opportunity to discuss a
few of them.
From an
infectious perspective, this man is at risk of Health Care Associated Pneumonia
(HCAP). The significance being that he
may be at risk for infections by organisms that may not be usually thought of
the Community Acquired Pneumonia setting.
The Infectious Diseases Society of America (IDSA) Guideline (2005) about
this topic can be found here and it lists the following as risk factors for
HCAP:
-
Hospitalization for 2 days or more in previous 90 days
- Residence in a
nursing home or extended care facility
- Home infusion
therapy (including antibitoics)
- Chronic
dialysis within 30 days
- Home wound
care
- Family member
with multi-drug resistant pathogen
Dr. Page
reminded us that much of the literature is based in the U.S. environment and
that local ecology of organisms (rate of drug resistant organisms) may be quite
different. It is important to consider
the local experience here. If you are
interested in this concept, here are 2 recent review papers: Am J Med (2011) and Curr Opin Infect Dis (2012).
Also, it is
important NOT to forget viral causes of pneumonia. A recent Lancet paper on this topic can be
found here. You can find flu activities in
Ontario and Toronto in the Flu Bulletin here (For 2 weeks ending July 7, 2012,
Toronto showed sporadic activity). For the 2 weeks ending on July 7, 2012, parainfluenza virus and entero/rhinovirus had the most number of positive specimens.
We also
discussed briefly that patients born in the pre-war period (in Canada and
Europe) are at risk of TB.
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