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Archive 1

Palliative addition.[edit]

Looking over archives, it seems no one bothered to follow through with the addition of "the old man's friend" reference. Will do so now.

The lead does not technical need refs as long as it is supported by the body. I do now always fully ref the leads as this is such a common misunderstanding. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:23, 27 June 2014 (UTC)

CAP review[edit]

NEJM doi:10.1056/NEJMra1312885 JFW | T@lk 21:09, 23 October 2014 (UTC)

"Currant jelly"[edit]

Tip: "Currant Jelly" should become hyperlinked to Red Currant (Ribes Rubrum) article. — Preceding unsigned comment added by (talk) 11:12, 9 November 2014 (UTC)

This suggestion prompts me to question the inclusion of "currant jelly" and similar descriptions in a Featured Article. As some have argued in the context of intussusception (PMID 9148991), it is unclear whether such terms are accurate or effective. I ask just to ensure we're deliberate about including such descriptions, when perhaps they are familiar "lore" from the teaching wards, but not actually useful. In a WP context, while I am aware that this term appears in reliable sources, is it sufficiently notable to be included? -- Scray (talk) 16:06, 9 November 2014 (UTC)


... pneumonia guideline National Institute for Health and Clinical Excellence. Clinical guideline 191: Pneumonia: Diagnosis and management of community- and hospital-acquired pneumonia in adults. London, December 2014. JFW | T@lk 22:04, 4 December 2014 (UTC)

Typical and atypical[edit]

The article contains the following statement:

"Infective agents were historically divided into "typical" and "atypical" based on their presumed presentations, but the evidence has not supported this distinction, thus it is no longer emphasized.[18]."

Reference 18 is listed as "Murray and Nadel (2010). Chapter 32." I do not have access to this particular source, but my understanding was that this differentiation was based on the causative pathogen. Atypical bacteria such as Legionella, Chlamydophilia and Mycoplama differ from S. pneumoniae and the various Gram-(-) pathogens not simply in "presentation", but in the mode of treatment. Atypical bacteria lack a cell wall, and thus are not susceptible to beta lactam antibiotics (whose mode of action is interference with cell wall synthesis). It is the potential involvment of these atypical bacteria that requires that a macrolide, tetracycline, or quinolone be included in empiric therapy. Is anyone aware of any reason that I should not correct this passage per the above discussion and identification of an appropriate source? Formerly 98 (talk) 14:07, 5 January 2015 (UTC)

I have access to that text and that is what it says. Can pull up the direct quote if you want. These terms are following out of favor in the clinical context. Doc James (talk · contribs · email) 14:12, 5 January 2015 (UTC)

"The division of CAP into typical and atypical syndromes has been used to predict the likely pathogens and select appropriate empirical therapy. 4 5 6 7 The clinical picture of “typical” CAP is that of disease characteristically caused by bacteria such as S. pneumoniae , H. influenzae , and K. pneumoniae . The initial presentation is frequently acute, with an intense and unique chill. Productive cough is present, and the expectoration is purulent or bloody. Pleuritic pain may be present and it is a very specific finding of S. pneumoniae . Physical examination reveals typical findings of pulmonary consolidation. There is leukocytosis with neutrophilia and the presence of band forms. Chest radiography shows lobar condensation with air bronchograms. In contrast, the syndrome of gradual onset of fever, nonproductive cough, and a relatively normal white blood cell count in a patient without a demonstrable bacterial pathogen has been called “atypical pneumonia.” Frequently, systemic complaints are more prominent than the respiratory ones. The atypical syndrome is characteristic of infections by pathogens such as M. pneumoniae ,Chlamydophila spp., C. burnetii , and viruses. Unfortunately, several studies, including one that included patients with mild CAP treated on an outpatient basis,39 have found that neither the clinical symptoms nor the radiographic manifestations are sufficiently sensitive or specific to reliably guide pathogen-directed antibiotic treatment against “typical” versus “atypical” microorganisms.39 Therefore, current guidelines do not emphasize the use of the typical versus atypical classification to determine initial empirical antibiotic treatment for CAP."

Atypical versus typical is not about the organism but the presenting symptoms. Have adjusted the wording i question and moved it. Doc James (talk · contribs · email) 14:31, 5 January 2015 (UTC)

Thanks. Agree that treatment guidelines point to empiric therapy covering all likely pathogens. Should we have a second sentence for most common pathogens in HAP? Much larger contribution from MRSA and Pseudomonas, though its complicated by the fact that most HAP is really VAP. Formerly 98 (talk) 14:59, 5 January 2015 (UTC)
Do we have data on hospital acquired but not ventilator assciated? Doc James (talk · contribs · email) 15:17, 5 January 2015 (UTC)
I'm not sure I've seen them split out explicitly, but I'll have a look. Formerly 98 (talk) 15:19, 5 January 2015 (UTC)
I think its most commonly VAP. I found one source for non-VAP HAP pathogens. Technically its secondary, but I don't know if you'll like it. It mainly emphasizes S. aureus and the frequency of polymicrobial infections.
Some good data here, not sure its a secondary ref. (talk) 15:26, 5 January 2015 (UTC)