Search

Pneumonia belongs to the most frequent and most deadly infectious diseases worldwide. It represents an increasing problem for the aging population. The incidence and mortality rises with every decade. The clinical presentation of pneumonia differs between elderly and younger patients. Multiple factors including functional status (self-dependency and immobilization), comorbidities, immunosenescence, nutritional status, swallowing disorders have to be accounted for. Pneumonia in the elderly has to be differentiated from nursing home acquired pneumonia. Diagnosis of pneumonia of the elderly demands special attention as the diagnostic value of common biomarkers and prognostic scores is different.

Human rhinoviruses (RV) belong to the Picornaviridae and are divided into three species: rhinovirus A, B and C. As causative viruses of upper airway infections (common cold), they possess enormous epidemiological and clinical importance. Furthermore, rhinoviruses are significant pathogens of acute exacerbations of chronic airway diseases such as asthma and chronic obstructive pulmonary disease. Their role as a cofactor in the development of pneumonia and their relevance in critically ill patients is still unclear and the focus of current research. Due to the unspecific clinical symptoms, diagnosis is difficult. Laboratory detection is sophisticated and a distinction between clinically relevant infection and contamination not always possible. Specific therapeutic antiviral strategies against rhinovirus infection do not exist as yet and, due to the large variety of subtypes, the development of vaccines remains a considerable challenge.

Chronic Pseudomonas aeruginosa colonization in the airways of patients with chronic obstructive pulmonary disease (COPD) is probably associated with increased mortality and morbidity and a faster progress of COPD, although this has not been conclusively proven by studies. Studies demonstrating an improvement in prognosis in COPD patients by early eradication of Pseudomonas or at least a reduction of the bacterial burden by either inhaled or oral antibiotic maintenance therapy, are missing. An impact on the exacerbation rate has only been shown for macrolide maintenance treatment; however, this effect could be explained by the inclusion of patients with bronchiectasis in the studies. This is a group of patients for whom the effect of this kind of antibiotic treatment is well known. Further studies on the prevention and treatment of chronic Pseudomonas colonization in COPD patients are urgently needed. The stability of the respiratory microbiome probably plays an essential role in the course of the disease and should be established as a study endpoint.

Influenza infections have important socio-economic consequences. Risk groups identified so far include small children and elderly adults with comorbidities. In recent years in addition to seasonal influenza an outbreak of avian influenza occurred in 2005 and the new H1N1 pandemic occurred in 2009. For the latter other at risk groups were affected and a different clinical course has been documented. The focus of this article is to give an overview on the epidemiology, clinical characteristics, diagnosis and therapy of influenza infections.

Respiratory viruses have been shown to be important respiratory pathogens. The majority of upper respiratory tract infections and most uncomplicated cases of acute tracheobronchitis are due to respiratory viral infections 1. Moreover, respiratory viruses play an important role as infective triggers of acute exacerbations of chronic respiratory diseases such as asthma 2–5 and chronic obstructive pulmonary disease (COPD) 6–8. Human rhinoviruses (HRVs) were by far the most frequent respiratory viruses detected in most of the studies cited. Hence, HRVs can be considered as very important respiratory pathogens in upper and lower respiratory tract infections. In particular, the role of HRVs in exacerbations of asthma and COPD makes them an important therapeutic target. …