Why Are The Elderly So Vulnerable To Pneumonia?

A study featured on the cover of the March 15 Journal of Immunology is providing insight into why the elderly are so vulnerable to pneumonia and other bacterial infections.

The study has been published online in advance of print.

Compared with younger adults, the elderly are at higher risk of becoming seriously ill or dying from pneumonia. Moreover, vaccines against the disease are less effective in the elderly.

To help understand why, Loyola researchers examined two types of immune system cells, macrophages and B cells, located in specialized areas in the spleens of mice. (Macrophages gobble up bacteria, while B cells produce antibodies that fight bacteria.)

Macrophages and B cells appeared to be just as effective in old mice as they were in younger mice. But there were fewer of them.

"If we knew how to replenish these cells, we might be able to lower the risk of bacterial infections in the elderly," said senior author Pamela Witte, a professor in the Department of Microbiology and Immunology at Loyola University Chicago Stritch School of Medicine. "This is an unexplored area in aging."

The finding also could provide clues to developing vaccines against pneumococcal pneumonia that would be more effective in the elderly, said first author Shirin Birjandi, who is completing her PhD at Loyola.

For example, Birjandi said, current vaccines instruct B cells to make antibodies against bacteria that cause pneumonia. But if humans are like mice, the elderly will have fewer B cells. So it might make more sense to develop vaccines that instead target other immune system cells, Birjandi said.

In their study, Loyola researchers examined B cells and macrophages that form microscopic rings in the spleen called marginal zones. These marginal zones form protective rings, preventing bacteria from passing through.

Photographs taken by the researchers show that in the spleens of young mice, macrophages form distinct rings in the marginal zones. (One of these photos appears on the cover of the Journal of Immunology.) In old mice, however, the photographs show that marginal zone rings are dramatically disrupted. (In humans, the equivalent ages of the old mice would be between 70 and 80.)

Researchers wrote that understanding changes such as these "is important for developing more efficient therapies for preventing diseases, such as bacterial pneumonia, that have shown to be highly detrimental in the elderly."

Other co-authors of the study are Jill Ippolito and Anand Ramadorai.

The research was supported by grants from the National Institutes of Health.

Source:
Loyola University Health System

Scientists Identify Novel Role for Lipids in Pneumonia

A study of mouse and human lung fluid revealed a fatty molecule that may play an unexpected role in the breathing difficulties of pneumonia. The finding could open the door to entirely new approaches for treating this sometimes-deadly condition.

Pneumonia is a serious lung disease and a leading cause of death in all age groups. Bacteria are the most common cause in adults, but respiratory viruses and fungal infections can also trigger the disease. Pneumonia arises when the airways become inflamed and filled with fluid in response to an infection. Symptoms include coughing, fever, chills and trouble breathing.

Bacterial pneumonia is usually treated with antibiotics. With the emergence of drug-resistant bacteria, scientists have been seeking new therapies that target underlying disease mechanisms rather than targeting the microbes. To date, few non-antibiotic therapies have been found to improve the outcomes of patients with severe pneumonia.

To learn more about at how bacterial pneumonia harms the lungs at the molecular level, a research team led by Dr. Rama Mallampalli at the University of Pittsburgh School of Medicine took a closer look at the fluid that naturally bathes the airways and tiny air sacs. The study was supported primarily by NIH’s National Heart, Lung and Blood Institute (NHLBI) and the U.S. Department of Veterans Affairs.

As reported in the October 2010 issue of Nature Medicine, the researchers analyzed lung fluid from humans and mice with pneumonia. They discovered abnormally high levels of a fatty molecule, or lipid, called cardiolipin. Cardiolipin is typically found in the outer membranes of mitochondria and bacteria, but it’s also known to be a minor component of healthy lung fluid.

When the scientists administered cardiolipin to mice, the animals’ lung function declined and the resulting tissue damage appeared similar to human pneumonia. Additional experiments confirmed that elevated cardiolipin appears to harm lung tissue.
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Updated Recommendations for Prevention of Invasive Pneumococcal Disease Among Adults Using the 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23)

Invasive disease from Streptococcus pneumoniae (pneumococcus) is a major cause of illness and death in the United States, with an estimated 43,500 cases and 5,000 deaths among persons of all ages in 2009 (1). This report provides updated recommendations from the Advisory Committee on Immunization Practices (ACIP) for prevention of invasive pneumococcal disease (IPD) (i.e., bacteremia, meningitis, or infection of other normally sterile sites [2]) through use of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) among all adults aged ≥65 years and those adults aged 19--64 years with underlying medical conditions that put them at greater risk for serious pneumococcal infection. The new recommendations include the following changes from 1997 ACIP recommendations (2): 1) the indications for which PPSV23 vaccination is recommended now include smoking and asthma, and 2) routine use of PPSV23 is no longer recommended for Alaska Natives or American Indians aged <65>2). ACIP recommendations for prevention of pneumococcal disease among infants and youths aged ≤18 years using the 13-valent pneumococcal conjugate vaccine (PCV13) and PPSV23 are published separately (3).
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Estimates of Deaths Associated with Seasonal Influenza --- United States, 1976--2007

Influenza infections are associated with thousands of deaths every year in the United States, with the majority of deaths from seasonal influenza occurring among adults aged ≥65 years (1--4). For several decades, CDC has made annual estimates of influenza-associated deaths, which have been used in influenza research and to develop influenza control and prevention policy. To update previously published estimates of the numbers and rates of influenza-associated deaths during 1976--2003 by adding four influenza seasons through 2006--07, CDC used statistical models with data from death certificate reports. National mortality data for two categories of underlying cause of death codes, pneumonia and influenza causes and respiratory and circulatory causes, were used in regression models to estimate lower and upper bounds for the number of influenza-associated deaths. Estimates by seasonal influenza virus type and subtype were examined to determine any association between virus type and subtype and the number of deaths in a season. This report summarizes the results of these analyses, which found that, during 1976--2007, estimates of annual influenza-associated deaths from respiratory and circulatory causes (including pneumonia and influenza causes) ranged from 3,349 in 1986--87 to 48,614 in 2003--04. The annual rate of influenza-associated death in the United States overall during this period ranged from 1.4 to 16.7 deaths per 100,000 persons. The findings also indicated the wide variation in the estimated number of deaths from season to season was closely related to the particular influenza virus types and subtypes in circulation.

The current study extends estimates of influenza-associated deaths from two previous CDC studies (2,3) by adding data from four more influenza seasons for a total of 31 influenza seasons (1976--2007). Estimates are provided for three age groups (<19>1) and can be considered a lower bound for deaths associated with influenza (2,4). However, a diagnosis of influenza virus infection often is not confirmed with sensitive and specific laboratory diagnostics, particularly among older persons, and even when identified is rarely recorded on death certificates (5). Many deaths associated with influenza infections occur from secondary infections such as bacterial pneumonia or complications of chronic conditions such as congestive heart failure and chronic obstructive pulmonary disease (6). Therefore, estimates using underlying respiratory and circulatory mortality data (which include pneumonia and influenza causes) can provide an upper bound for influenza-associated deaths (2,7).
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New Report Finds Low Adult Vaccination Rates For Pneumonia In U.S.

from Medical News Today

A new report, Adult Immunization: Shots to Save Lives, released by the Trust for America's Health (TFAH), the Infectious Diseases Society of America (IDSA), and the Robert Wood Johnson Foundation (RWJF) found that more than 30 percent of adults ages 65 and older had not been immunized against pneumonia in 36 states as of 2008. The U.S. Centers for Disease Control and Prevention (CDC) and other experts recommend that all seniors should be vaccinated against pneumonia, which is a one-time shot for most individuals, since seniors who get the seasonal flu are at risk for developing pneumonia as a complication.
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Western Baptist Hospital: Problem Solving with Pneumonia Care Performance Improvement Teams

Western Baptist Hospital is one of the top-performing hospitals in the country in the pneumonia care process-of-care, or "core" measures. The core measures, developed by the Hospital Quality Alliance (HQA) and publicly reported by the Centers for Medicare and Medicaid Services (CMS), relate to provision of recommended treatment in four clinical areas: heart attack, heart failure, pneumonia, and surgical care. Western Baptist also performs well, above the 85th percentile, on the heart attack and heart failure core measures, though it does not perform as well-below the 50th percentile-on the surgical care core measures.

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Air Pollution Linked To Hospitalizations For Pneumonia In Seniors

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A McMaster University researcher has found the first evidence that prolonged exposure to higher levels of the pollutants found in car exhaust fumes and industrial air pollution can lead to hospitalization for pneumonia in adults aged 65 and older.

Infectious disease specialist Mark Loeb led a research team to assess the effect of long-term exposure to nitrogen dioxide and sulfur dioxide, both found in motor vehicle emissions, and fine particulate matter, found in industrial air pollution, on the risk of hospitalization for pneumonia in older adults. Loeb, a physician, is a professor in the Department of Pathology and Molecular Medicine and the Department of Clinical Epidemiology and Biostatistics of the Michael G. DeGroote School of Medicine.
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• Air pollution linked to hospitalizations for pneumonia in seniors (scienceblog.com)
• Car exhaust fumes linked to pneumonia in seniors (cbc.ca)
• Air pollutants linked to severe pneumonia in seniors (ctv.ca)
• Air Pollution Raises Pneumonia Risk In Seniors (inquisitr.com)
• Air Pollution and Pneumonnia in Seniors (blisstree.com)
• Dirty Air May Raise Pneumonia Risk (nlm.nih.gov)

St. Luke's Medical Center: Bottom-Up Approach to Quality Improvement in Pneumonia Care

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St. Luke's Medical Center has made significant improvements in its performance on the pneumonia care core measures over the last five years. The core measures, developed by the Hospital Quality Alliance, relate to achievement of recommended treatment in four clinical areas: heart attack, heart failure, pneumonia, and surgical care. St. Luke's, which was once achieving as low as 30 percent to 50 percent compliance with the pneumonia care core measures, now performs well above state and national averages. It also performs above the 90th percentile on other core measures.
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Parkview Medical Center: Underscoring the Importance of Communication in Pneumonia Care

Parkview Medical Center is one of the top-performing hospitals in the country in the pneumonia process-of-care measures, or "core," measures. The core measures, developed by the Hospital Quality Alliance, relate to achievement of recommended treatment in four clinical areas: heart attack, heart failure, pneumonia, and surgical care. In addition to performing strongly in the pneumonia care core measures, Parkview has achieved 99 percent compliance in the heart failure core measures. Hospital leaders credit the organization's strong performance in pneumonia care to the regular communication and reinforcement provided by quality improvement staff. Concurrent review in particular is relied on as an opportunity to provide real-time education and reminders to providers at the point of care. Those interviewed also emphasize that the hospital leaders are willing to try anything in the name of improving patient care.