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La pneumonie aiguë communautaire (PAC) est la première cause de prescription d'antibiotiques. Diminuer l'utilisation des antibiotiques permet de lutter contre l'antibiorésistance. À ce jour, trois études randomisées ont montré la non-infériorité d'un schéma court d'antibiothérapie (3j versus 7j) dans la PAC. L'objectif de cette étude était d'évaluer cette stratégie individualisée de réduction de la durée d'antibiothérapie dans la PAC en vie réelle. Cette étude rétrospective observationnelle a inclus tous les patients avec pneumonie hospitalisés dans un service de médecine interne du 01/11/2022 au 31/05/2023. L'antibiothérapie, de 3 jours au minimum, était stoppée dès que le patient avait atteint les critères de stabilité clinique. Parmi les 49 patients inclus, de 72 ans en médiane, la durée médiane d'antibiothérapie était de 4 jours (IQR 3-6), et le taux de guérison à j30 était de 88 %. À j30, un décès (2 %), quatre reprises d'antibiotiques (9 %), et deux réhospitalisations ont été observés chez cinq patients immunodéprimés. Parmi les patients immunodéprimés (n = 17 ; 35 %), le taux d'échec était trois fois plus élevé en cas de traitement court (3/8, 38 %), comparé au traitement long (1/7, 14 %). Une stratégie d'interruption de l'antibiothérapie reposant sur l'obtention des critères de stabilité clinique dès j3 est facile à mettre en place dans un service de médecine, et permet de diminuer la durée d'antibiothérapie sans perte notable d'efficacité pour des patients immunocompétents avec pneumonie. Pneumonia is one of the most common indications for antibiotic. Shortening the duration of antibiotic therapy should help reduce bacterial resistance. To date, three randomized control trials have shown non-inferiority of short courses of antibiotic therapy (3 days) compared with 7 days in non-severe pneumonia. The aim of this study was to assess this strategy in real life. This retrospective observational cohort study included all patients with pneumonia hospitalized in an internal medical ward from 11/01/2022 to 05/31/2023. We implemented the strategy based on early discontinuation of antibiotic therapy in patients with pneumonia who were clinically stable after 3 days of β-lactam treatment. Among 49 patients included, median age was 72, median antibiotic duration was 4 days (IQR 3-6), and cure rate at D30 was 88 %. At day 30, we observed one death (2 %), four new antibiotic therapy (9 %), and two new hospitalisation (5 %), among five immunosuppressed patients. Among immunosuppressed patients (n = 17; 35 %), failure rate was three times higher in case of short antibiotic courses (3/8; 38 %) than long antibiotic courses (1/7; 14 %). Strategy based on early discontinuation of antibiotic therapy in immunocompetent patients with pneumonia who were clinically stable after 3 days of β-lactam treatment is safe, and easy to implement in a medical ward. [ABSTRACT FROM AUTHOR]

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Zusammenfassung: Hintergrund: Bei Patienten mit nosokomialer bakterieller Pneumonie ist die Mortalität am höchsten bei denjenigen, die so weit dekompensieren, dass eine mechanische Beatmung (vHABP) nötig wird, gefolgt von denen mit beatmungsassoziierter Pneumonie (VABP) und nicht beatmungsassoziierter, im Krankenhaus erworbener Pneumonie (nvHABP). Die Ziele dieser Studie waren die Identifizierung von Risikofaktoren, die mit der Entwicklung und der Mortalität von vHABP assoziiert sind, und die Bewertung der Antibiotikabehandlung. Methoden: Eine multizentrische retrospektive Kohortenstudie wurde bei erwachsenen hospitalisierten Patienten mit nosokomialer Pneumonie zwischen 2014 und 2019 durchgeführt. Die Gruppen wurden nach vHABP, nvHABP und VABP stratifiziert und hinsichtlich demografischer Daten, klinischer Merkmale, Behandlung und Ergebnissen verglichen. Mithilfe von maschinellem Lernen wurden multivariate Modelle erstellt, um Risikofaktoren für die Progression zur vHABP und die Mortalität durch Pneumonie für jede Kohorte zu identifizieren. Ergebnisse: 457 Patienten (32% nvHABP, 37% vHABP und 31% VABP) wurden untersucht. Die vHABP- und die nvHABP-Gruppe waren ähnlich alt (medianes Alter 66,4 Jahre), 77% wiesen mehrere Komorbiditäten auf, aber mehr vHABP-Patienten hatten eine Lebererkrankung (18,2% vs. 7,7%; p = 0,05) und eine Alkoholkonsumstörung (27% vs. 7,1%; p < 0,001) und waren in den vorausgehenden 30 Tagen im Krankenhaus gewesen (30,4% vs. 19,5%; p = 0,02). 70% der vHABP-Patienten benötigten am Tag der Diagnose eine sofortige Beatmung. Die Mortalität war in der vHABP-Gruppe am höchsten, gefolgt von der VABP- und der nvHABP-Gruppe (44,6% vs. 36% vs. 14,3%; p < 0,0001). Fast alle (96%) vHABP-Patienten hatten positive Kulturen, wobei Gram-negative Erreger 58,8% ausmachten und 33,0% resistent gegen β-Laktame mit breitem Wirkungsspektrum (ESBL), Ceftriaxon (17,5%), Fluorchinolone (20,6%) und Carbapeneme (12,4%) waren. Bis zur Hälfte der vHABP-Patienten mit ESBL-Enterobacteriaceae oder Pseudomonas aeruginosa erhielten keine wirksame empirische Therapie. Bei Patienten, bei denen eine wirksame Therapie erst nach dem Tag der Pneumoniediagnose begonnen wurde, war die Mortalität um mehr als 50% erhöht. Risikofaktoren, die mit der Entwicklung einer vHABP assoziiert waren, waren Alkoholkonsumstörung, APACHE-II-Score, eine Vasopressortherapie vor der Infektion und eine positive Kultur für ESBL-Enterobacteriales, während eine Krankenhausaufnahme in den letzten 30 Tagen, eine aktive maligne Erkrankung, die Isolierung von Ceftriaxon-resistenten Erregern oder P. aeruginosa und eine Vasopressortherapie Risikofaktoren für eine vHABP-assoziierte Mortalität waren. [ABSTRACT FROM AUTHOR]

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Mycoplasma pneumoniae is a common atypical pathogen causing comunitary-acquired pneumonia (CAP), mostly in children and young adults with age between 5 and 40 years old. Beyond respiratory symptoms, extra-pulmonary features are described, such as skin rash, arthralgia, gastrointestinal symptoms, and heart disease, occurring in less than 5% to 10% of patients. This case refers to a 26-year-old patient, without significant medical history or (1) background treatment, immunocompetent, who is presenting to the emergency room for prolonged fever, and conjunctival suffusions. Following the investigations, pneumonia, and conjunctivitis due to atypical bacteria are suspected and appropriate treatment is administered. Along with other multiple infectious agents that could precipitate a respiratory febrile infection with ocular involvement, we should consider also Mycoplasma pneumoniae as a possible cause. Appropriate antibiotic therapy may result in a favorable, but delayed course of the disease. [ABSTRACT FROM AUTHOR]

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Copyright of Innere Medizin (2731-7080) is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

La pneumonie liée au cytomégalovirus humain (hCMV) est principalement connue comme une atteinte d'organe potentiellement grave chez les patients immunodéprimés. Cependant, la réactivation pulmonaire du CMV peut aggraver le pronostic de patients admis en réanimation pour d'autres causes, indépendamment de leur statut immunitaire initial. Cette revue a pour but d'aborder l'épidémiologie, la physiopathologie, les outils diagnostiques et les aspects cliniques de la pneumonie liée au hCMV en différenciant les tableaux du patient immunodéprimé et immunocompétent de réanimation. Les stratégies thérapeutiques et les nouvelles molécules disponibles sont également traitées. Les interactions virales, en particulier avec le Sars-CoV-2, sont des perspectives de recherche dans la compréhension de la pathogénie du hCMV. Human Cytomegalovirus (hCMV) related pneumonia is mainly known as a potentially severe end organ disease in immunocompromised patients. However, hCMV lung reactivation can also alter the prognosis of critically ill patients, irrespective of their initial immune status. In this review, we focus on the epidemiology, physiopathology, diagnostic tools and clinical aspects of hCMV related pneumonia. We also summarize therapeutic strategies with an update on the old and new molecules to consider. Conclusion open up on research perspectives concerning the virus's physiopathology such as SARS-CoV-2 and CMV virusvirus interactions. [ABSTRACT FROM AUTHOR]

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Copyright of Nouveau Praticien Vétérinaire Canine & Féline is the property of EDP Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Innere Medizin (2731-7080) is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Post-stroke dysphagia is highly prevalent and leads to severe complications, such as aspiration pneumonia and malnutrition. Despite the high clinical relevance dysphagia management is heterogeneous and often inadequate. Objective: The aim of this review article is to provide an overview of the diagnostic and treatment strategies for post-stroke dysphagia based on recent studies. Material and methods: Narrative literature review. Results: Dysphagia screening should be performed as early as possible in every stroke patient, e.g., with a simple water swallowing test or a multiconsistency protocol. Subsequently, flexible endoscopic evaluation of swallowing (FEES) is indicated in patients with abnormal screening results or existing risk factors for dysphagia. Dietary modifications, oral hygiene measures, and nutritional therapy can help reduce complications. Behavioral swallowing therapy or experimental therapies, such as neurostimulation procedures and pharmacological approaches aim to improve swallowing function and have shown promising results in studies. Conclusion: Timely management of dysphagia is necessary to reduce complications. [ABSTRACT FROM AUTHOR]

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Introduction. In view of the continuing development of vaccines for various diseases, there is a need not only to keep health professionals informed, but also to understand how they perceive the risks of certain diseases for certain groups of patients. It is particularly important to identify how the perception of immunizations by both the medical profession and the direct beneficiaries, the patients, can be influenced. Materials and method. The study was based on a survey of 42 family physicians attending a symposium on the management of patients with Streptococcus pneumoniae infection. Data had been collected from participants before they heard the lectures at the event. Results. The information gathered from the survey revealed that doctors consider it useful for the health system to support immunization programs in order to increase immunization rates. It also revealed that the way one vaccination campaign is carried out can influence another, and that the doctor has a significant role in influencing the patient’s immunization. Conclusions. The success of vaccination campaigns in ensuring a good immunization rate depends on a good correlation between the involvement of the health system through the national immunization program, the health insurance system and the work of doctors who can significantly influence the patient’s decision to be vaccinated. [ABSTRACT FROM AUTHOR]

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Abstract: Pulmonary opacities are among the most common findings that general practitioners and internists have to interpret in everyday life. Conventional chest x-rays are still important, but computed tomograms often provide additional information. Patient history, clinical examination but also additionally collected laboratory findings are important prerequisites for the interpretation of imaging studies. Likewise, radiological patterns should be recognized and correctly described. The density, distribution to one or both sides, basal or apical, unifocal or multifocal, also the involvement of the interstitial tissue, bronchioles, the alveolar space and pleura can provide decisive differential diagnostic information. Space-occupying or shrinking processes may be suspected on behalf of the course of pleural lines. Tumours may be differentiated from shrinking lung volume as seen in atelectasis by shift of the mediastinum or the shape of pleural lines. Occasionally control images can support the interpretation of the radiological results. [ABSTRACT FROM AUTHOR]

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Copyright of Zeitschrift für Herz-, Thorax- und Gefaesschirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Introduction: Pneumocystis jirovecii is a fungal pathogen that causes a serious infection called Pneumocystis pneumonia - abbreviated PCP - in people with an immunosuppression condition (e.g.: HIV infection, cancer, organ transplant, inflammatory or autoimmune diseases, treatment with immunosuppressants like corticosteroids), with a high mortality rate. Methods: We searched the PubMed database for publications describing risk factors responsible for the occurrence of Pneumocystis pneumonia, without restrictions of country or English language. The following search terms were used: (("Pneumocystis"[Mesh]) AND "Pneumonia, Pneumocystis"[Mesh]) AND "Risk Factors"[Mesh], for a period of six years, between 2017 and 2022. Data on the type of study and clinical characteristics of the infection caused by Pneumocystis jirovecii in immunodepressed and immunocompetent patients have been extracted. We identified 41 articles, of which 11 have been considered as relevant and are the basis of the present analysis according to our inclusion criteria. Conclusions: The review of the literature to this end shows that patients who have been exposed to the risk factors such as: advanced age with a preponderance in men, nosocomial transmission via human contamination, those with an immunocompromised immune system due to the deficiency of Mannose-binding lectin (MBL) expression and end-stage renal disease disease (ESRD) who do CCRTx, concurrent chemoradiotherapy or RTx, radiotherapy and are treated with immunosuppressive drugs such as: prednisolone (PSL), calcineurin inhibitor, tumor necrosis factor anti-TNF-a, thioprine, mycophenolate mofetil (MMF) and rituximab there is suspicion to developing Pneumocystis pneumonia, should be carefully diagnosed and managed through an appropriate early prophylaxis. In conclusion, in our opinion more deep studies are necessary in this regard. [ABSTRACT FROM AUTHOR]

Infecţiile pulmonare rămân o cauză principală de morbiditate şi mortalitate la persoanele HIV infectate şi una dintre cele mai frecvente cauze de internare în spitale a acestor pacienţi. Deseori stabilirea diagnosticul de pneumonie la pacienţii cu imunitate compromisă este dificilă, existând un spectru larg de infecţii oportuniste (bacteriene, fungice, virale, parazitare, tuberculoase etc.), dar şi o listă extinsă de alte cauze de febră şi modificări imagistice pulmonare, cum ar fi embolii, tumori, atelectazii, sau dezvoltarea simultană a infecţiilor în alte sisteme de organe (digestiv, renal), fiind necesare mai multe investigaţii pentru confirmarea diagnosticului la imunocompromis faţă de pacientul imunocompetent

Insuficienţa severă de valvă mitrală instalată acut este printre cauzele frecvente ale unei complicaţii mai rar diagnosticate cum este edemul pulmonar unilateral, iar sindromul de consolidare localizat la nivelul lobului superior al plămânului drept, ar putea fi considerat un indiciu sugestiv la un pacient cu sindrom coronarian acut. Prezentăm cazul unei paciente care a dezvoltat edem pulmonar unilateral cauzat de regurgitare mitrală acută din infarct miocardic, rezolvat prin aplicare de proteză mecanică de valvă mitrală, monitorizat pe parcursul a 4 ani postintervenţie

Copyright of Medicina Pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Studia Pneumologica et Phthiseologica is the property of TRIOS, spol. sr.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Datele din literatura de specialitate demonstrează că evaluarea în următoarele 3-6 luni a pacienților diagnosticați cupneumonie SARS-CoV-2 evidențiază persistența modificărilor la CT /Rx toracică, de rând cu afectarea semnificativă afuncției pulmonare. Sunt necesare studii suplimentare care sa evalueaze impactul pe termen lung și să clarifice consecințele bolii pentru a garanta monitorizarea și tratamentul optim pentru pacienții care au suportat pneumonia SARS-CoV-2.

Infection with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) may present as the common cold, or in a series of cases can also result in severe or fatal pneumonia with severe respiratory distress. Since the virus's first appearance in December 2019, multiple studies have focused on clinical manifestations and biological features of different COVID variants in these five pandemic waves. Also, the variety of symptoms, the severity of the disease and the assessment of risk factors in each individual has continuously evolved among these two years, due to updated data published worldwide. The current paper presents the case of two patients, husband and wife, who develop a similar COVID-19 infection with only mild symptoms, although their disease history and COVID vaccination status is very different. They were among the first confirmed Omicron variant cases by genome sequencing in Romania and their favorable outcome despite the risk factors was encouraging for our every day practice. [ABSTRACT FROM AUTHOR]

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Introducere. Aproximativ 12 milioane de copii mor anual ȋn țările ȋn curs de dezvoltare, iar o treime din aceste decese sunt cauzate de pneumonii. Evaluarea modificărilor radiologice în dinamică are un rol major în stabilirea diagnosticului de pneumonie stafilococică. Scopul lucrării este de a sublinia dificultățile de diagnostic și tratament într-un caz de pneumonie stafilococică la copil. Prezentarea cazului. Prezentăm cazul unui pacient, de sex masculin, în vârstă de 2 ani și 6 luni, internat în clinica noastră pentru hiperpirexie, tuse productivă, rinoree și inapetență. Examenul clinic la internare a pus ȋn evidență stare generală influențată, facies palid, suferind, febră, tuse productivă, rinoree, murmur vezicular diminuat pe partea dreaptă, saturație ȋn oxigen 97%, și inapetență, iar analizele de laborator leucocitoză marcată cu neutrofilie, anemie și markeri inflamatori intens crescuți. Radiografia toracică a pus ȋn evidență un focar congestiv la nivelul lobului inferior drept. Hemocultura a fost negativă. S-a inițiat tratament simptomatic și antibiotic (Ceftriaxonă), dar datorită evoluției nefavorabile, radiografia de control a arătat o zonă de condensare bazal drept asociind o colecție pleurală ȋnchistată bazal și laterotoracic drept. Am efectuat și computer tomografie (CT) toracică, evidențiindu-se un proces pneumonic bisegmentar ȋn lobul inferior drept, cu câteva pneumatocele grupate subpleural, asociind ȋn ambii plămâni arii de hiperinflație lobulară. Astfel, se ridică suspiciunea unei pneumonii verosimil stafilococice, motiv pentru care se asociază Vancomicină iv, cu evoluție favorabilă. Concluzii. Pneumonia stafilococică este o patologie bine definită şi cunoscută ȋn literatură, dar rămâne totuşi o patologie contemporană, impunând multiple dificultăţi legate de diagnosticul şi managementul cazurilor pediatrice.

Objective: Our aim in this study was to systematically assess the association of sodium-glucose cotransporter-2 inhibitors (SGLT2i) vs dipeptidyl peptidase-4 inhibitors (DPP4i) with pneumonia, COVID-19, and adverse respiratory events in patients with type 2 diabetes mellitus (DM)., Methods: PubMed, Embase, and Cochrane Library databases were retrieved to include studies on DM patients receiving SGLT2i (exposure group) or DPP4i (control group). Stata version 15.0 statistical software was used for the meta-analysis., Results: Ten studies were included, all 10 of which were used for the qualitative review and 7 for the meta-analysis. According to the meta-analysis, patients receiving SGLT2i had a lower incidence of pneumonia (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.51 to 0.74) and pneumonia risk (OR 0.63, 95% CI 0.60 to 0.68, p=0.000) compared with those receiving DPP4i. The same situation was seen for mortality for pneumonia (OR 0.49, 95% CI 0.39 to 0.60) and pneumonia mortality risk (OR 0.47, 95% CI 0.42 to 0.51). There was lower mortality due to COVID-19 (OR 0.31, 95% CI 0.28 to 0.34) and a lower hospitalization rate (OR 0.61, 95% CI 0.56 to 0.68, p=0.000) and incidence of mechanical ventilation (OR 0.69, 95% CI 0.58 to 0.83, p=0.000) due to COVID-19 in patients with type 2 DM receiving SGLT2i. Qualitative analysis results show that SGLT2i were associated with a lower incidence of COVID-19, lower risk of obstructive airway disease events, and lower hospitalization rate of health-care-associated pneumonia than DPP4i., Conclusion: In patients with type 2 DM, SGLT2i are associated with a lower risk of pneumonia, COVID-19, and mortality than DPP4i., (Copyright © 2024 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

Introduction: Pneumonia is one of the most common indications for antibiotic. Shortening the duration of antibiotic therapy should help reduce bacterial resistance. To date, three randomized control trials have shown non-inferiority of short courses of antibiotic therapy (3 days) compared with 7 days in non-severe pneumonia. The aim of this study was to assess this strategy in real life., Method: This retrospective observational cohort study included all patients with pneumonia hospitalized in an internal medical ward from 11/01/2022 to 05/31/2023. We implemented the strategy based on early discontinuation of antibiotic therapy in patients with pneumonia who were clinically stable after 3 days of β-lactam treatment., Results: Among 49 patients included, median age was 72, median antibiotic duration was 4 days (IQR 3-6), and cure rate at D30 was 88 %. At day 30, we observed one death (2 %), four new antibiotic therapy (9 %), and two new hospitalisation (5 %), among five immunosuppressed patients. Among immunosuppressed patients (n=17; 35 %), failure rate was three times higher in case of short antibiotic courses (3/8; 38 %) than long antibiotic courses (1/7; 14 %)., Conclusion: Strategy based on early discontinuation of antibiotic therapy in immunocompetent patients with pneumonia who were clinically stable after 3 days of β-lactam treatment is safe, and easy to implement in a medical ward., (Copyright © 2024 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Objective: Comparison of diagnostic efficiency of Light's parameters with cytological-energy analysis parameters of pleural effusion. Design: retrospective. Settings: Biomedical Centre, Krajská zdravotní, a. s. - Masaryk Hospital in Ústí nad Labem, o. z.; Department of Clinical Immunology and Allergology, Faculty of Medicine and University Hospital in Hradec Králové, Charles University in Prague; Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, s.r.o; Department of Thoracic Surgery, Krajská zdravotní, a.s. - Masaryk Hospital in Usti nad Labem, o.z.; Department of Clinical Biochemistry, Krajská zdravotní, a.s. - Masaryk Hospital in Ústí nad Labem, o.z. Material and Methods: The 96 samples of noninflammatory pleural effusions of patients with cardiac failure or systemic sepsis, the 211 samples of pleural effusions of patients with purulent pneumonia and the 283 samples of pleural effusions of patients with chest empyema were analysed. In all cases, we analysed selected parameters of Light criteria (total number of nuclear elements in 1 µl, concentration of total protein, glucose, lactate and catalytic activity of lactate dehydrogenase (LDH)) and parameters of cytological-energy analysis (frequency of neutrophils, KEB value and catalytic activity of aspartate aminotransferase (AST)). Statistical analysis was performed using the ANOVA Kruskal-Wallis test and ROC-analysis. Results: We found significant differences of parameters of Light's criteria and cytological-energy analysis between inflammatory and noninflammatory pleural effusions (p < 0.01). We found significant differences between patients with purulent pneumonia and chest empyema (p < 0.01). Light's criteria parameters included total number of nuclear elements, concentration of total protein, lactate and catalytic activities of LDH. Cytological-energy parameters included KEB value and catalytic activities of AST. We found high diagnostic accuracy of „Light's" concentration of glucose (AUC = 0.981), lactate (AUC = 0.970) and catalytic activities of LDH (AUC = 0.962) and „cytological-energy" frequency of neutrophils (AUC = 0.982), KEB values (AUC = 0.999) and catalytic activities of AST (AUC = 0.954) to distinguish between noninflammatory and parapneumonic pleural effusions. We found high diagnostic accuracy of „Light's" total number of nuclear elements (AUC = 0.939), concentration of glucose (AUC = 0.967), lactate (AUC = 0.987) and catalytic activities of LDH (AUC = 0.984) and „cytological-energy" frequency of neutrophils (AUC = 0.985), KEB values (AUC = 0.991) and catalytic activities of AST (AUC = 0.979) to distinguish between noninflammatory pleural effusions and pleural effusions of patients with chest empyema. We found low diagnostic accuracy of all parameters to distinguish parapneumonic effusion and pleural effusion of patients with chest empyema: „Light's" total number nuclear elements (AUC = 0.714), concentration of glucose (AUC = 0.631), lactate (AUC = 0.721), total protein (AUC = 0.537) and catalytic activities of LDH (AUC = 0.710) and „cytological-energy" frequency of neutrophils (AUC = 0.553), KEB values (AUC = 0.671) and catalytic activities of AST (AUC = 0.718). Conclusion: The advantage of cytological-energy analysis versus Light's criteria parameters is in their abilities to characterize a local immune response considering the energy state. Both methods complement each other appropriately. In any case, they do not contradict each other. [ABSTRACT FROM AUTHOR]

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Introduction: Pneumonias still represent a real problem in the public health system despite all progress made in the field of diagnosis principles and treatment. Identifying the pathogen as well as differentiating community-acquired pneumonia from non-community-acquired pneumonia are to be aimed in order to deploy appropriate treatment management, and thus reducing the risk of developing complications Objective: Identification and differentiation of community acquired and non-community acquired pneumonia in order to identify and treat early possible complications such as reactivation of pulmonary tuberculosis. Discussions: The particularity of the case is that we have a patient without known immunodeficiencies, who develops non-community acquired pneumonia with Klebsiella Pneumoniae, with the reactivation of tuberculosis. Conclusions: Non-community acquired pneumonia requires special attention and a high degree of suspicion of possible complications, with careful follow-up of imaging and laboratory investigations in dynamics. Although it is considered that this pathology is relatively easy to diagnose and treat, in some cases it can pose real problems of differential diagnosis and requires a multidisciplinary approach. [ABSTRACT FROM AUTHOR]