ascorbic-acid and Pneumonia--Bacterial

Community-acquired pneumonia (CAP) remains one of the most common reasons for paediatric morbidity and accounts for about 16% of all the deaths occurring in children less than 5 years of age. Areas covered: The main aim of this paper is to discuss the emerging problems for CAP treatment in paediatric age. Expert commentary: Official recommendations for therapeutic approaches to paediatric CAP, despite being not very recent, seem still to be the best solution to assure the highest probabilities of cure for children with this disease living in industrialized countries. Amoxicillin remains the drug of choice and use of macrolides alone or in combination does not seem supported by solid evidence. Corticosteroids can be useful in CAP associated with bronco-obstruction, whereas their effectiveness in cases with a severe inflammatory response, although plausible, is not supported by data collected through randomized, placebo-controlled trials. Finally, for the administration of vitamin C and vitamin D, the available data are not adequate to draw firm conclusions regarding the real importance of supplementation. Further studies are needed to evaluate which modifications of presently available recommendations for paediatric CAP treatment can improve final prognosis of this still common disease.

Topics: Anti-Bacterial Agents; Ascorbic Acid; Community-Acquired Infections; Evidence-Based Medicine; Glucocorticoids; Humans; Pneumonia, Bacterial; Vitamin D

The incidence of pneumonia for elderly persons living in the community is 14 cases/1000 persons/y, whereas 33/1000 nursing home residents require hospitalization for pneumonia each year. Premorbid health status is more important than age in determining outcome from pneumonia in this age group. Two studies of mortality in the 2 years following pneumonia gave conflicting results. One study showed that the mortality rate was twice that which was expected. Both the clinical and radiographic diagnosis of pneumonia may be difficult in the elderly especially if there is co-existing congestive heart failure. Aspiration is an under-diagnosed cause of pneumonia in the elderly. Data from three randomized clinical trials indicate that intravenous antibiotic therapy can be changed to oral therapy when the patient has been afebrile (< 37.5 degrees C) for 16 hours, can take antibiotics by mouth, and has a leukocyte count returning towards normal. Adjunctive therapy with nutritional supplements and vitamin C may improve outcome in this group of patients. Yearly immunization with influenza A and B virus vaccine will reduce both the incidence of pneumonia and the rate of hospitalization for this infection. A discussion of pneumonia in the elderly is often divided into community-acquired pneumonia, which is treated at home or in a nursing home, or community-acquired pneumonia requiring hospitalization and nosocomial pneumonia. The latter is not described in this review.

Topics: Administration, Oral; Age Factors; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ascorbic Acid; Community-Acquired Infections; Cross Infection; Health Status; Hospitalization; Humans; Incidence; Influenza Vaccines; Injections, Intravenous; Leukocyte Count; Nursing Homes; Nutritional Support; Pneumonia, Bacterial; Pneumonia, Viral; Randomized Controlled Trials as Topic; Survival Rate; Treatment Outcome

Methemoglobinemia is a rare disorder of the blood in which there is an increase in methemoglobin, which occurs when hemoglobin is present in the oxidized form. Methemoglobin impairs hemoglobin's ability to transport oxygen, produces functional anemia, and leads to tissue hypoxia. We report the successful management of a case of refractory hypoxia due to acutely acquired methemoglobinemia in a patient undergoing treatment for coronavirus disease 2019 (COVID-19) pneumonia. The cause of methemoglobinemia in this patient remains unknown. Hypoxia and methemoglobinemia did not respond to methylene blue and required administration of packed red blood cell transfusions.

Topics: Acute Kidney Injury; Aged; Antibodies, Monoclonal, Humanized; Antioxidants; Ascorbic Acid; Betacoronavirus; Coronavirus Infections; Corynebacterium; Corynebacterium Infections; COVID-19; Cytokine Release Syndrome; Enzyme Inhibitors; Erythrocyte Transfusion; Hematinics; Humans; Hydroxocobalamin; Hydroxychloroquine; Hypoxia; Male; Methemoglobinemia; Methylene Blue; Pandemics; Pneumonia, Bacterial; Pneumonia, Viral; Renal Replacement Therapy; Respiratory Insufficiency; SARS-CoV-2; Shock, Septic

The authors describe the case of a 46-year-old man, who developed atypical pneumonia caused by Coxiella burnetii. Chest X-ray revealed interstitial pneumonia. Western blot and ELISA test were positive for Coxiella burnetii antibody. After treatment with doxycyclin and amoxicillin supplemented with vitamin B6 for 10 days, the patient displayed a clinical improvement. The authors conclude that in cases with atypical pneumonia, Coxiella burnetii antibody as well as other bacterial or viral antibodies should be determined.

Topics: Acetylcysteine; Amoxicillin-Potassium Clavulanate Combination; Antibodies, Bacterial; Ascorbic Acid; Coxiella burnetii; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Humans; Male; Middle Aged; Pneumonia, Bacterial; Prisoners; Q Fever; Silymarin; Treatment Outcome

Vitamin C deficiency is rare in developed countries but there is an increased prevalence in chronic alcohol abusers. In the UK, it is common practice to treat patients with chronic alcoholism who are admitted to hospital with intravenous vitamins B1, B2, B3, B6 and C for 2-3 days, followed by oral thiamine and vitamin B-compound tablets. This is a case of a 57-year-old man with a history of chronic alcoholism and chronic obstructive lung disease who was admitted to the intensive care unit for pneumonia requiring ventilatory support. He was given high doses of intravenous vitamins B1, B2, B3, B6 and C for 3 days then oral thiamine and vitamin B compound tablets but developed scurvy 4 days later. He was restarted on oral vitamin C supplementation and showed signs of improvement within 3 days of treatment.

Topics: Alcoholism; Ascorbic Acid; Humans; Male; Middle Aged; Niacinamide; Pneumonia, Bacterial; Riboflavin; Scurvy; Thiamine; Vitamin B 6; Vitamin B Complex; Vitamins