In August 2018, the World Health Organization (WHO) issued an advisory statement regarding anticipated modifications to their recommended treatment approach for adults with MDR-TB; the statement prioritizes use of oral agents over injectable agents [38]. Pending finalization of the WHO guidelines, we favor substitution of bedaquiline for the injectable agent; expert consultation is essential. (See "Treatment of drug-resistant pulmonary tuberculosis in adults", section on 'Conventional regimen'.)
Mortality due to community-acquired pneumonia in the United States (October 2018)
Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. In a retrospective review of 2320 adults hospitalized with CAP at five tertiary care centers in the United States, 52 (2.2 percent) died during hospitalization [39]. Approximately half of those deaths were directly attributable to CAP, and more than 60 percent occurred in patients ≥65 years old and those with multiple comorbidities. A lapse in the quality of care (eg, delayed or inappropriate antibiotic use) that could have contributed to death was identified in four patients. While mortality in this study was low, it highlights that early recognition of those at risk for poor outcomes and prompt treatment is critical to care. (See "Prognosis of community-acquired pneumonia in adults", section on 'In-hospital and postdischarge mortality'.)
Phrenic neuropathy in patients with neuralgic amyotrophy (August 2018)
Unilateral or bilateral phrenic neuropathy causing diaphragm dysfunction can occur in patients with neuralgic amyotrophy, a common cause of nontraumatic brachial plexopathy, but it is not well studied and may be overlooked clinically. A recent study identified over 100 patients with clinical diaphragm dysfunction, representing approximately 7 percent of a larger cohort of patients with neuralgic amyotrophy [40]. The most common symptoms were exertional dyspnea, sleep disturbance, and orthopnea. Supine and sitting spirometry should be performed in patients suspected of having phrenic neuropathy, as chest radiograph has suboptimal sensitivity, particularly when involvement is bilateral. Many patients improve spontaneously within two years, although others have persistent symptoms. (See "Brachial plexus syndromes", section on 'Clinical variability'.)
Advisory Committee on Immunization Practices recommendations for influenza vaccination for the 2018 to 2019 season (August 2018)
The United States Advisory Committee on Immunization Practices recommendations for the 2018 to 2019 influenza season include live attenuated influenza vaccine (LAIV) as an option for appropriate patients [41,42]. This is a change from the previous two influenza seasons, during which LAIV was not recommended because it had low effectiveness against H1N1 influenza in children [42]. The manufacturer subsequently changed the H1N1 strain used to produce the vaccine to one with better replicative fitness and immunogenicity, comparable to the one used to make the vaccine in prior seasons in which LAIV was effective against H1N1 viruses. (See "Seasonal influenza vaccination in adults", section on 'Live attenuated vaccine' and "Seasonal influenza in children: Prevention with vaccines", section on 'Choice of vaccine'.)
Rifampin for latent tuberculosis infection (August 2018)
Regimen preference for treatment of latent tuberculosis infection (LTBI) is based largely on the likelihood of adherence and the potential for adverse effects; thus far, no regimen has been shown to be of superior efficacy. In two randomized trials including more than 6800 adults and 800 children with LTBI, rifampin daily for four months (4R) resulted in similar efficacy for prevention of active tuberculosis but better adherence rates compared with isoniazid daily for nine months (9H) [43,44].
Mortality due to community-acquired pneumonia in the United States (October 2018)
Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. In a retrospective review of 2320 adults hospitalized with CAP at five tertiary care centers in the United States, 52 (2.2 percent) died during hospitalization [39]. Approximately half of those deaths were directly attributable to CAP, and more than 60 percent occurred in patients ≥65 years old and those with multiple comorbidities. A lapse in the quality of care (eg, delayed or inappropriate antibiotic use) that could have contributed to death was identified in four patients. While mortality in this study was low, it highlights that early recognition of those at risk for poor outcomes and prompt treatment is critical to care. (See "Prognosis of community-acquired pneumonia in adults", section on 'In-hospital and postdischarge mortality'.)
Phrenic neuropathy in patients with neuralgic amyotrophy (August 2018)
Unilateral or bilateral phrenic neuropathy causing diaphragm dysfunction can occur in patients with neuralgic amyotrophy, a common cause of nontraumatic brachial plexopathy, but it is not well studied and may be overlooked clinically. A recent study identified over 100 patients with clinical diaphragm dysfunction, representing approximately 7 percent of a larger cohort of patients with neuralgic amyotrophy [40]. The most common symptoms were exertional dyspnea, sleep disturbance, and orthopnea. Supine and sitting spirometry should be performed in patients suspected of having phrenic neuropathy, as chest radiograph has suboptimal sensitivity, particularly when involvement is bilateral. Many patients improve spontaneously within two years, although others have persistent symptoms. (See "Brachial plexus syndromes", section on 'Clinical variability'.)
Advisory Committee on Immunization Practices recommendations for influenza vaccination for the 2018 to 2019 season (August 2018)
The United States Advisory Committee on Immunization Practices recommendations for the 2018 to 2019 influenza season include live attenuated influenza vaccine (LAIV) as an option for appropriate patients [41,42]. This is a change from the previous two influenza seasons, during which LAIV was not recommended because it had low effectiveness against H1N1 influenza in children [42]. The manufacturer subsequently changed the H1N1 strain used to produce the vaccine to one with better replicative fitness and immunogenicity, comparable to the one used to make the vaccine in prior seasons in which LAIV was effective against H1N1 viruses. (See "Seasonal influenza vaccination in adults", section on 'Live attenuated vaccine' and "Seasonal influenza in children: Prevention with vaccines", section on 'Choice of vaccine'.)
Rifampin for latent tuberculosis infection (August 2018)
Regimen preference for treatment of latent tuberculosis infection (LTBI) is based largely on the likelihood of adherence and the potential for adverse effects; thus far, no regimen has been shown to be of superior efficacy. In two randomized trials including more than 6800 adults and 800 children with LTBI, rifampin daily for four months (4R) resulted in similar efficacy for prevention of active tuberculosis but better adherence rates compared with isoniazid daily for nine months (9H) [43,44].