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Diagnostics
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Current Concepts in Diagnosis of Pneumonia
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Current Concepts in Diagnosis of Pneumonia

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Diagnostic Microbiology and Infectious Disease".

Deadline for manuscript submissions: closed (31 March 2021) | Viewed by 41109

Special Issue Editor

Dr. Marwan M. Azar

E-Mail Website
Guest Editor
Yale University, New Haven, CT, USA

Special Issue Information

Dear Colleagues,

Pneumonia is one of the most common medical syndromes encountered in clinical practice, the second most common cause of hospitalization and the most common infectious cause of death in the United States. Etiologies of pneumonia span the entire spectrum of known pathogens, including both typical and opportunistic bacterial, viral, parastic and fungal pathogens. Infections with multiple pathogens simulatenously are not uncommon, particularily among immunocompromised patients. Diagnosing pneumonia requires a constellation of microbiologic, radiographic and clinical criteria, but despite a battery of microbiologic tests, the underlying etiology remains elusive in up to 60% of cases. Conventional methods including cultures, stains and histopathology form the bedrock of diagnosis but also suffer from relatively poor sensitivity and slow turn around times, while antigen testing and serology are useful adjunctive methods, but sensitive and specific testing is available for only a limited range of organisms. Conversely, newer methods including multiplex PCR panels and, more recently, next-generation metagenomic sequencing are characterized by high sensitvity and rapid turnaround times but are hindered by poor specificity when not adequately taken into clinical context, leading to difficulties in result interpretation. Nonetheless, emerging methods promise to alter the diagnotic landscape of pneumonia, allowing for more targetted therapy and better clinical outcomes.

Dr. Marwan M. Azar
Guest Editor

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Pneumonia
  • Diagnostics
  • Conventional microbiology testing
  • Antigen and serology
  • PCR
  • Metagenomics
  • Emerging microbiology testing
  • Immunocompromised

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Published Papers (7 papers)

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Review

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14 pages, 304 KiB  
Review
Diagnosis of Multidrug-Resistant Pathogens of Pneumonia
by Maroun M. Sfeir
Diagnostics 2021, 11(12), 2287; https://doi.org/10.3390/diagnostics11122287 - 7 Dec 2021
Cited by 8 | Viewed by 2988
Abstract
Hospital-acquired pneumonia and ventilator-associated pneumonia that are caused by multidrug resistant (MDR) pathogens represent a common and severe problem with increased mortality. Accurate diagnosis is essential to initiate appropriate antimicrobial therapy promptly while simultaneously avoiding antibiotic overuse and subsequent antibiotic resistance. Here, we [...] Read more.
Hospital-acquired pneumonia and ventilator-associated pneumonia that are caused by multidrug resistant (MDR) pathogens represent a common and severe problem with increased mortality. Accurate diagnosis is essential to initiate appropriate antimicrobial therapy promptly while simultaneously avoiding antibiotic overuse and subsequent antibiotic resistance. Here, we discuss the main conventional phenotypic diagnostic tests and the advanced molecular tests that are currently available to diagnose the primary MDR pathogens and the resistance genes causing pneumonia. Full article
(This article belongs to the Special Issue Current Concepts in Diagnosis of Pneumonia)
17 pages, 755 KiB  
Review
Laboratory Diagnosis of SARS-CoV-2 Pneumonia
by Melissa R. Gitman, Maryia V. Shaban, Alberto E. Paniz-Mondolfi and Emilia M. Sordillo
Diagnostics 2021, 11(7), 1270; https://doi.org/10.3390/diagnostics11071270 - 15 Jul 2021
Cited by 18 | Viewed by 15815
Abstract
The emergence and rapid proliferation of Coronavirus Disease-2019, throughout the past year, has put an unprecedented strain on the global schema of health infrastructure and health economy. The time-sensitive agenda of identifying the virus in humans and delivering a vaccine to the public [...] Read more.
The emergence and rapid proliferation of Coronavirus Disease-2019, throughout the past year, has put an unprecedented strain on the global schema of health infrastructure and health economy. The time-sensitive agenda of identifying the virus in humans and delivering a vaccine to the public constituted an effort to flatten the statistical curve of viral spread as it grew exponentially. At the forefront of this effort was an exigency of developing rapid and accurate diagnostic strategies. These have emerged in various forms over the past year—each with strengths and weaknesses. To date, they fall into three categories: (1) those isolating and replicating viral RNA in patient samples from the respiratory tract (Nucleic Acid Amplification Tests; NAATs), (2) those detecting the presence of viral proteins (Rapid Antigen Tests; RATs) and serology-based exams identifying antibodies to the virus in whole blood and serum. The latter vary in their detection of immunoglobulins of known prevalence in early-stage and late-stage infection. With this review, we delineate the categories of testing measures developed to date, analyze the efficacy of collecting patient specimens from diverse regions of the respiratory tract, and present the up and coming technologies which have made pathogen identification easier and more accessible to the public. Full article
(This article belongs to the Special Issue Current Concepts in Diagnosis of Pneumonia)
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16 pages, 994 KiB  
Review
Diagnosis of Pneumonia Due to Invasive Molds
by Carlo Foppiano Palacios and Anne Spichler Moffarah
Diagnostics 2021, 11(7), 1226; https://doi.org/10.3390/diagnostics11071226 - 7 Jul 2021
Cited by 8 | Viewed by 6156
Abstract
Pneumonia is the most common presentation of invasive mold infections (IMIs), and is pathogenetically characterized as angioinvasion by hyphae, resulting in tissue infarction and necrosis. Aspergillus species are the typical etiologic cause of mold pneumonia, with A. fumigatus in most cases, followed by [...] Read more.
Pneumonia is the most common presentation of invasive mold infections (IMIs), and is pathogenetically characterized as angioinvasion by hyphae, resulting in tissue infarction and necrosis. Aspergillus species are the typical etiologic cause of mold pneumonia, with A. fumigatus in most cases, followed by the Mucorales species. Typical populations at risk include hematologic cancer patients on chemotherapy, bone marrow and solid organ transplant patients, and patients on immunosuppressive medications. Invasive lung disease due to molds is challenging to definitively diagnose based on clinical features and imaging findings alone, as these methods are nonspecific. Etiologic laboratory testing is limited to insensitive culture techniques, non-specific and not readily available PCR, and tissue biopsies, which are often difficult to obtain and impact on the clinical fragility of patients. Microbiologic/mycologic analysis has limited sensitivity and may not be sufficiently timely to be actionable. Due to the inadequacy of current diagnostics, clinicians should consider a combination of diagnostic modalities to prevent morbidity in patients with mold pneumonia. Diagnosis of IMIs requires improvement, and the availability of noninvasive methods such as fungal biomarkers, microbial cell-free DNA sequencing, and metabolomics-breath testing could represent a new era of timely diagnosis and early treatment of mold pneumonia. Full article
(This article belongs to the Special Issue Current Concepts in Diagnosis of Pneumonia)
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18 pages, 1029 KiB  
Review
Diagnosis of Pulmonary Infections Due to Endemic Fungi
by Victoria Poplin, Clarissa Smith, Dominique Milsap, Lauren Zabel and Nathan C. Bahr
Diagnostics 2021, 11(5), 856; https://doi.org/10.3390/diagnostics11050856 - 10 May 2021
Cited by 13 | Viewed by 6404
Abstract
Endemic mycoses including Histoplasma, Blastomyces, Coccidioides, Paracoccidioides, and Talaromyces are dimorphic fungi that can cause a variety of clinical manifestations, including respiratory infections. Their pulmonary presentations are variable, and diagnosis is often delayed as they can mimic other infectious [...] Read more.
Endemic mycoses including Histoplasma, Blastomyces, Coccidioides, Paracoccidioides, and Talaromyces are dimorphic fungi that can cause a variety of clinical manifestations, including respiratory infections. Their pulmonary presentations are variable, and diagnosis is often delayed as they can mimic other infectious and non-infectious causes of pulmonary disease. Delay in diagnosis can lead to unnecessary antibiotic use, repeat hospitalizations, and increased morbidity and mortality. The diagnosis of endemic fungal pulmonary infections often relies on multiple diagnostic tests including culture, tissue histopathology, antigen assays, and antibody assays. Due to the increased use of immunosuppressive agents and the widening geographic ranges where these infections are being found, the prevalence of endemic fungal infections is increasing. Physicians need to be aware of the clinical manifestations of pulmonary infections due to endemic fungal in order to ensure that the proper diagnostic work up is obtained promptly. A high index of suspicion is particularly important in patients with suspected pulmonary infections who have failed to improve despite antibiotics in the appropriate setting. We present a review diagnostic testing for pulmonary infections due to endemic mycoses. Full article
(This article belongs to the Special Issue Current Concepts in Diagnosis of Pneumonia)
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Other

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2 pages, 210 KiB  
Reply
Response to Comment on Jaworska, J. et al. Consensus on the Application of Lung Ultrasound in Pneumonia and Bronchiolitis in Children. Diagnostics 2020, 10, 935
by Anna Komorowska-Piotrowska, Joanna Jaworska, Andrzej Pomiećko, Jakub Wiśniewski, Mariusz Woźniak, Błażej Littwin, Magdalena Kryger, Piotr Kwaśniewicz, Józef Szczyrski, Katarzyna Kulińska-Szukalska, Natalia Buda, Zbigniew Doniec and Wojciech Kosiak
Diagnostics 2021, 11(1), 66; https://doi.org/10.3390/diagnostics11010066 - 4 Jan 2021
Cited by 8 | Viewed by 1833
Abstract
Thank you for the opportunity to respond to the issues raised by Nenna et al [...] Full article
(This article belongs to the Special Issue Current Concepts in Diagnosis of Pneumonia)
3 pages, 163 KiB  
Comment
Comment on Jaworska, J. et al. Consensus on the Application of Lung Ultrasound in Pneumonia and Bronchiolitis in Children. Diagnostics 2020, 10, 935
by Raffaella Nenna, Elio Iovine, Marco Laudisa, Silvia Bloise, Domenico Paolo La Regina and Fabio Midulla
Diagnostics 2021, 11(1), 55; https://doi.org/10.3390/diagnostics11010055 - 4 Jan 2021
Cited by 3 | Viewed by 1689
Abstract
To the editor: [...] Full article
(This article belongs to the Special Issue Current Concepts in Diagnosis of Pneumonia)
15 pages, 602 KiB  
Guidelines
Consensus on the Application of Lung Ultrasound in Pneumonia and Bronchiolitis in Children
by Joanna Jaworska, Anna Komorowska-Piotrowska, Andrzej Pomiećko, Jakub Wiśniewski, Mariusz Woźniak, Błażej Littwin, Magdalena Kryger, Piotr Kwaśniewicz, Józef Szczyrski, Katarzyna Kulińska-Szukalska, Natalia Buda, Zbigniew Doniec and Wojciech Kosiak
Diagnostics 2020, 10(11), 935; https://doi.org/10.3390/diagnostics10110935 - 11 Nov 2020
Cited by 26 | Viewed by 5307
Abstract
This evidence-based consensus aims to establish the role of point-of-care lung ultrasound in the management of pneumonia and bronchiolitis in paediatric patients. A panel of thirteen experts form five Polish tertiary pediatric centres was involved in the development of this document. The literature [...] Read more.
This evidence-based consensus aims to establish the role of point-of-care lung ultrasound in the management of pneumonia and bronchiolitis in paediatric patients. A panel of thirteen experts form five Polish tertiary pediatric centres was involved in the development of this document. The literature search was done in PubMed database. Statements were established based on a review of full-text articles published in English up to December 2019. The development of this consensus was conducted according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluations)—adopted and Delphi method. Initially, 22 proposed statements were debated over 3 rounds of on-line discussion and anonymous voting sessions. A total of 17 statements were agreed upon, including four statements referring to general issues, nine referring to pneumonia and four to bronchiolitis. For five statements experts did not achieve an agreement. The evidence supporting each statement was evaluated to assess the strength of each statement. Overall, eight statements were rated strong, five statements moderate, and four statements weak. For each statement, experts provided their comments based on the literature review and their own experience. This consensus is the first to establish the role of lung ultrasound in the diagnosis and management of pneumonia and bronchiolitis in children as an evidence-based method of imaging. Full article
(This article belongs to the Special Issue Current Concepts in Diagnosis of Pneumonia)
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