[Management of Adult Community-Acquired Pneumonia and Prevention - Update 2021 - Guideline of the German Respiratory Society (DGP), the Paul-Ehrlich-Society for Chemotherapy (PEG), the German Society for Infectious Diseases (DGI), the German Society of Medical Intensive Care and Emergency Medicine (DGIIN), the German Viological Society (DGV), the Competence Network CAPNETZ, the German College of General Practitioneers and Family Physicians (DEGAM), the German Society for Geriatric Medicine (DGG), the German Palliative Society (DGP), the Austrian Society of Pneumology Society (ÖGP), the Austrian Society for Infectious and Tropical Diseases (ÖGIT), the Swiss Respiratory Society (SGP) and the Swiss Society for Infectious Diseases Society (SSI)]

The present guideline provides a new and updated concept of the management of adult patients with community-acquired pneumonia. It replaces the previous guideline dating from 2016.The guideline was worked out and agreed on following the standards of methodology of a S3-guideline. This includes a systematic literature search and grading, a structured discussion of recommendations supported by the literature as well as the declaration and assessment of potential conflicts of interests.The guideline has a focus on specific clinical circumstances, an update on severity assessment, and includes recommendations for an individualized selection of antimicrobial treatment.The recommendations aim at the same time at a structured assessment of risk for adverse outcome as well as an early determination of treatment goals in order to reduce mortality in patients with curative treatment goal and to provide palliation for patients with treatment restrictions.

Seltene virale Infektionen der Lunge

Die Lunge ist aufgrund ihres direkten Kontakts mit der Umwelt gegenüber einer Vielzahl von Viren exponiert. Im folgenden Beitrag werden Infektionen durch 4 virale Erreger dargestellt, die zu pulmonalen Manifestationen führen können, die in Deutschland aufgrund ihrer Seltenheit wenig bekannt sind. Bei der zoonotischen Influenza, dem „Middle East respiratory syndrome“ (MERS) und der Infektion durch Hantaviren handelt es sich um zoonotische Infektionen, während es sich bei den Masern um eine rein humane Erkrankung handelt. Allen 4 Infektionen gemein sind die potenziell schweren pulmonalen Komplikationen mit hoher Mortalität. Über den einzelnen Patienten hinaus können die Masern, MERS und auch die zoonotische Influenza zu weiteren Übertragungen mit weitreichenden Konsequenzen führen. Der Beitrag beleuchtet für die jeweiligen Erreger relevante Aspekte von Epidemiologie, klinischem Verlauf, Therapie und Prävention. Diese Kenntnisse erscheinen wichtig, da jederzeit mit dem Auftreten von Fällen in Deutschland gerechnet werden muss.

Seltene parasitäre Infektionen der Lunge

Pulmonale parasitäre Infektionen kommen weltweit vor, werden jedoch aufgrund der Seltenheit in Deutschland in den wenigsten Fällen differenzialdiagnostisch in Betracht gezogen. Parasitäre Lungenerkrankungen können unterschiedlichste pulmonale Manifestationen hervorrufen und sollten bei unklaren Befunden oder fehlendem Therapieansprechen differenzialdiagnostisch mit bedacht werden, um diese heilbaren Erkrankungen so früh wie möglich zu erkennen.

[Statement of the Austrian Society of Pneumology (ASP)]

The COVID-19 pandemic is currently a challenge worldwide. In Austria, a crisis within the health care system has so far been avoided. The treatment of patients with community-acquired pneumonia (CAP), including SARS-CoV‑2 infections, should continue to be based on evidence-based CAP guidelines during the pandemic. However, COVID-19-specific adjustments are useful. The treatment of patients with chronic lung diseases must be adapted during the pandemic, but must still be guaranteed.

Comparison of clinical presentation and laboratory values at admission between PCR-confirmed influenza A H1N1 infection and influenza-like disease, South-East Austria

PURPOSE

Reliable and rapid diagnosis of influenza A H1N1 is essential to initiate the appropriate antiviral therapy and preventive measures. As PCR assays are time-consuming and rapid antigen tests have a limited sensitivity, official influenza case definitions are used in many clinical settings. These, however, are based exclusively on clinical criteria and have only a moderate potential to differentiate between influenza and other febrile diseases. Only limited data on the differences in clinical and laboratory parameters between influenza and non-influenza febrile diseases are available to date.

METHODS

This was a retrospective case-negative control series that was conducted in Styria, southeast Austria. We analyzed the differences in clinical presentation and laboratory admission parameters between patients with PCR-confirmed H1N1 influenza infection (n = 199) and those with influenza-like disease and negative influenza PCR results (ILD group; n = 252).

RESULTS

In the multivariable analysis lower C-reactive protein (CRP) level, lower white blood cell (WBC) count, fever, wheezing, cough, and the absence of nausea or sudden onset remained significant predictors of H1N1 influenza in adult patients (n = 263). Lower CRP level, lower WBC count, and cough remained significant predictors in pediatric patients (<16 years; n = 188).

CONCLUSION

Lower CRP level, lower WBC count, and cough were significant predictors of H1N1 in both the adult and pediatric patient group. These data may help to develop an improved case definition for suspected H1N1 infection which combines clinical findings and easily available laboratory parameters.

[Myopexia posterior with tissue adhesive (author's transl)]

Myopexia posterior with tissue adhesive has many advantages over the classic procedure employed in the Cüppers "Fadenoperation". The technique presents few complications, is simple, time-saving and causes no trauma. After experiments on animals, we have now successfully employed this technique on human ocular muscles.

[Infiltrating retinoblastoma - a difficult differential diagnosis (author's transl)]

The diffuse infiltrative retinoblastoma closely resembles uveitis, because of a pseudohypopyon and vitreous infiltration. Since late diagnosis endangers the lives of the children affected, the authors describe two cases of this rare and unusual clinical picture.

[Unilateral myopia in children (author's transl)]

In cases of high unilateral myopia good prognosis for monocular visual acuity as well as binocular vision is expected if timely and cosistent therapy is administered. Therapy comprises full optical correction, amblyopia therapy, mostly occlusion, squint therapy and possibly fitting of contact lenses. The author presents 31 cases of unilateral high myopic children up to age 12 with anisometropia between 4 and 19 dioptres. Although the aniseikonia in cases of high unilateral myopia increases with contact lenses as compared to spectacles for geometric optical reasons, we obtained good results with contact lens correction. Examination show that the child's brain adapts very well to the aniseikonia. Complicate correction with aniseikonic lenses is thus neither necessary nor advantageous.

[Occlusion contact lenses (author's transl)]

A reliable inconspicuous occlusion therapy is achieved by fitting different, specially manufactured contact lenses. Based on a study of a number of cases, the author discusses the indications for a occlusion contact lens. These lenses provide a means for treating amblyopia in schoolchildren and adults, as well as for eliminating diplopia, photophobia and metamorphopsia.

Smoking artifacts: factors of source evaluation

Responses from 323 students in communication indicated that credibility factors associated with nonverbal smoking artifacts are not the same as those associated with verbal stimuli; a character factor was absent for nonverbal stimuli. Verbosity, however, may permit inferences regarding potential verbal behavior.

[Synthetic, absorbable suture in eye-muscle surgery (author's transl)]

A synthetic, absorbable suture (Vicryl), was investigated for its usability in eye-muscle surgery. In experimental investigations on animals and strabismus surgery in humans, properties of the suture were compared with those of plain catgut. Histological investigations after modified strabismus surgery on rabbits clearly showed a smaller degree of tissue reaction around the hydrolytically dissolvable synthetic suture than around plain catgut. After implantation of Vicryl or catgut into the anterior chamber of rabbit eyes, within the first eight days both cause infective reactions which were somewhat stronger with Vicryl, which caused more scarring over the iris, than with catgut. One-hundred and eighty strabismus operations on man showed that the synthetic suture handles better and rips less markedly than plain catgut, whereas duration and amount of postoperative irritations are similar. Overreactions and granuloma were rare.

[Unilateral aphakia in childhood (author's transl)]

The monocular and binocular vision will always be disturbed after unilateral cataract extraction in childhood. The treatment therefore not only means operation, but also correction of the optic error, pleoptics and orthoptics. In 40 cases of unilateral aphakia (12 congenital, 28 traumatical) the prognosis depends on the age of the individual and maintenance of treatment. The older the child and the sooner therapy is started the better are the functional results.