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Streptococcus pneumoniae remains the most commonly identified pathogen in community-acquired pneumonia (Fig. Previously seen mainly in extended-care facilities and acute-care hospitals, strains of methicillin-resistant Staphylococcus aureus (MRSA) have emerged as prevalent pathogens in community settings.6 Necrotizing pneumonia is a characteristically severe manifestation of these virulent strains. A new human pathogen, severe acute respiratory syndrome (SARS)-associated coronavirus, emerged and spread worldwide in the winter of 2002 to 2003. Influenza continues to be a prevalent seasonal disease in the United States, causing considerable morbidity, loss of productivity, and mortality. Many pathogens listed as potential agents of bioterrorism are spread by the respiratory route. Six mechanisms have been identified in the pathogenesis of pneumonia in immunocompetent adults (Table 2). The aspiration of oropharyngeal or gastric contents is the most prevalent pathogenetic mechanism in nosocomial pneumonia, with several contributing factors.
Direct inoculation rarely occurs as a result of surgery or bronchoscopy but may play a role in the development of pneumonia in patients supported with mechanical ventilation.
Reactivation of pathogens can take place in the setting of deficits of cell-mediated immunity. Once bacteria reach the tracheobronchial tree, defects in local pulmonary defenses can make infection more likely.
Because the clinical syndromes characterizing pneumonic infections caused by various agents often overlap one another and because interobserver variability regarding physical findings of pneumonia is high, the diagnosis of pneumonia can be challenging. SARS manifests with high fever and myalgia for 3 to 7 days, followed by a nonproductive cough and progressive hypoxemia, with progression to mechanical ventilation in 20% of cases.
A cornerstone of diagnosis is the chest x-ray, which is recommended for diagnosis in every circumstance and usually reveals an infiltrate (Fig. Although radiographic patterns are usually nonspecific, they can suggest a microbiologic differential diagnosis (Table 4).
When community-acquired pneumonia is strongly suspected on the basis of history, physical examination, and chest radiography, the next critical management decision is whether the patient requires hospital admission. Adapted from Kolleff MH, Micek ST: Methicillin-resistant Staphylococcus aureus—a new community-acquired pathogen? All others were evaluated with the laboratory tests listed in Table 5 and assigned to risk classes by point totals (Table 6). When the patient is not severely ill (ie outpatient treatment or not severely ill in the inpatient setting) and has few risk factors, the consensus guidelines of the Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS)10 suggest empirical therapy without extensive laboratory evaluation (Box 1). Other stains, such as the acid-fast stain for mycobacteria, modified acid-fast stain for Nocardia, or toluidine blue and Gomori's methenamine silver stains should be used when directed by the history or clinical presentation. The sputum culture remains a controversial tool but is useful to help tailor therapy when the patient is severely ill, has a history of structural lung disease or alcohol abuse, has pleural effusion, or has evidence of pneumococcal or Legionella infection.
When these procedures fail to yield a microbiologic diagnosis and when the patient does not respond to empirical antibiotic therapy, more-invasive diagnostic techniques may be indicated. A more substantial amount of lung tissue may be obtained for culture and histologic examination by thoracoscopic or open lung biopsy. Often relegated to retrospective or epidemiologic interest because of delays in testing or reporting, serologic testing for such pathogens as Legionella species, Mycoplasma species, and C. The sputum Gram stain and culture are controversial, but they are still useful for targeting antimicrobial therapy when the patient is severely ill or immunocompromised. Molecular methods are playing an increasing role in identifying difficult-to-culture pathogens. The pneumonia severity index uses history, examination, chest radiograph, and initial laboratory test results to identify low-risk patients for outpatient treatment. Antibiotic therapy for community-acquired pneumonia should always be selected with patient characteristics, place of acquisition, and severity of disease in mind. Clindamycin is preferred over penicillin for the treatment of community-acquired aspiration pneumonia because of its superiority for treating oral anaerobes such as Bacteroides melaninogenicus. Suspected or proven inhalation anthrax should be treated with ciprofloxacin or doxycycline and two other agents (see Table 7).
Although few data specifically address the duration of therapy, many cases of pneumonia are adequately treated with 10 to 14 days of antibiotics. The use of oral or switch therapies offers potential reductions in duration of stay, antibiotic administration costs, complications of venous access, and disruption of families and careers.
Worsening of clinical status despite adequate antibiotic therapy should trigger a reassessment of the original clinical impression. Antibiotic therapy for community-acquired pneumonia should always be selected with patient characteristics, place of acquisition, severity of disease, and local resistance patterns in mind.
Most pneumonias, with some exceptions, can be cured with 10 to 14 days of antibiotic therapy.
Failure to respond to initial therapy should raise questions of diagnosis, treatment adherence, and antimicrobial resistance. Immunization against influenza and increasingly resistant pneumococci can play a critical role in preventing pneumonia, particularly in immunocompromised and older adults. The pneumococcal vaccine has been shown to be 60% to 70% effective in immunocompetent patients. Residual immunity against Bordetella pertussis wanes over time, leading to transmission from older adults to other adults and infants.
The emergence of SARS, with significant spread in hospitals, forced an extensive reassessment of respiratory infection control in many institutions.
A number of expert bodies have developed guidelines for the diagnosis and management of community-acquired pneumonia.
Treatment recommendationsare closely aligned with prior guidelines from the individual organizations.
When new respiratory pathogens emerge or major flares of well-known respiratory diseases occur, information develops quickly and guidelines are altered on a real-time basis. With regard to site of care, the PORT data have suggested a less than 1% risk of 30-day mortality for pneumonia sufferers falling into risk classes I and II of the pneumonia severity index, suggesting the possibility of outpatient care for this group.
Mandell LA, Bartlett JG, Dowell SF, et al: Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Fine MJ, Auble TE, Yealy DM, et al: A prediction rule to identify low-risk patients with community-acquired pneumonia. Gleckman R, DeVita J, Hibert D, et al: Sputum gram stain assessment in community-acquired bacteremic pneumonia.
Ramsdell J, Narsvage GL, Fink JB, et al: Management of community-acquired pneumonia in the home. Metlay JP, Hofmann J, Cetron MS, et al: Impact of penicillin susceptibility on medical outcomes for adult patients with bacteremic pneumococcal pneumonia. Fine MJ, Smith MA, Carson CA, et al: Prognosis and outcomes of patients with community-acquired pneumonia. Houck PM, Bratzler DW, Nsa W, et al: Timing of antibiotic administration and outcomes for Medicare patients hospitalized with pneumonia. In Germany and Austria today there are signs of the seriousness with which geopathic stress is taken. If you find time, this geopathic stress documentary is extremely interesting and compliments the work I have been doing over the last 12 years and 30 years my father before me with the same conclusions. Please scroll down the articles on this page for a more scientific understanding of geopathic stress.
There is also an interesting piece of research at the end of the page about the credibility of Vega testing for geopathic stress.
The most useful research document is below under the heading a€?Vienna Reporta€™ Read my summary and then either open up the original research document in German or the Poor English translation after the summary. The first studies that proved a link between cancer and geopathic stress were carried out in the early 20th century in Austria and Germany but, so far geopathic stress has been largely ignored in the UK. A A A  Long term exposure in combination with other types of energy such as Hartman lines, high electromagnetic fields or geological faults can give rise to optimistic abnormal cell growth and cancer.
Germany has long been the seat of research in to the biological effects that pathogenic locations can have on both human and plant biochemistry.
Historic roots of the investigation are built on claims that pathogenic zones exist at certain locations and that sleeping or spending long periods of time above them are linked to cancer, debilitating diseases of the central nervous system, chronic fatigue and general ill health. The research was conducted by a team of distinguished professors, doctors, engineers, scientists and dowsers. To test this hypothesis the research team used the services of three dowsers known for there expertise in locating earth energies. At present, these so called a€?Disturbed Zonesa€™ can only be indicated by dowsers, with its presence being then verified with scientific instrumentation. The Project a€?The project involved the testing of 24 different biological parameters involving 985 trial volunteers in 6,943 investigations using 462, 421 individual measurements.
Decoder Analysis of the Total Bioelectric Status a€?This investigation was significant and was carried out on a number of patients from a country medical practice.
Heart Frequency Reaction (HFR) a€?In these investigations measurements from an electrocardiogram (ECG) were used in both sitting and lying down positions.
Akrale Re-warming Time a€?The temperature measurement at the finger tips revealed that after standardized cooling on the a€?Disturbed Zonea€™ the Rewarming time is delayed significantly. Optical Flicker Fusion Frequency a€?This test measures the psycho sensory capabilities of the person. Coordinative Vegetative Rhythm a€?Passive rhythms such as breath and pulse frequency operate in balanced Coordinative rhythms especially when at rest. Muscle Frequency Analysis a€?Significant location variations in the distribution of the muscle action frequencies were found in areas of electric muscle potential. Calcium and Potassium a€?On a€?Disturbed Zonesa€™ potassium levels increased with a rising significance and calcium increased significantly. Serotonin a€?Decreased by a factor of 6 on the a€?Disturbed Zonea€™ whilst increasing its metabolism to advance Tryptophan in compensation. The a€?Location Effecta€™ of the a€?Disturbed Zonea€™ on regulatory systems of the human organism is proved without doubt and raises the question of which substratum, subsystem or system the location dependent powers primarily attack.
The test results were lined up by Biometric Significance and are valued with the Serotonin and the Blood Corpuscle Decline Speed (BSG) in lead position. Serotonin a€?Serotonin is diminished on the a€?Disturbed Zonea€™ and its metabolism advances the tendency for Tryptophan to be increased.
The research team concluded that there was no evidence to relate a€?Location Loada€™ to a specific illness but should be rather determined as a risk factor that can reinforce the effect of different pathogenic factors.
Only rudimental evidence is available today, if such zones could be measured using accepted physical apparatus.
One of the reasons why an incontrovertible physical measurement of the assumedly existing electromagnetic fields appears to be impossible at present could be that these are very variable, broad-banded and at the same time only present in very low power strengths, a€?hiddena€? in the surrounding electromagnetic noise.
One can assume that there are many origins for the effects of different locations on humans, animals and plants.
Low energy, broad-banded and dynamically changing EMFs, creating resonance with structures of the human organism, may well be part of the geopathy phenomenon. In addition, the dipolar nature of H2O-molecules can also be part of the origin of such fields. Piezoelectricity is the ability of certain crystals and certain ceramic materials to generate electrical and magnetic signals in response to applied mechanical stress. Inside an ideal quartz crystal, the electrical charge of the elements silicon and oxygen cancel each other out. Another well known use of piezoelectricity is found in lighters using piezoelectric ignition: There, sudden mechanical pressure onto a synthetic quartz crystal block (containing high amounts of exactly aligned synthetic lattice crystal cells) leads to the generation of high voltage. Another aspect of the geopathy phenomenon, which appears to be largely underestimated in its importance, could be found in the presence of a€?longitudinal scalar wavesa€? (5).
The existence of longitudinal wave proportions, as also present in the near field of a dipol antenna, could already be shown experimentally by Nikola Tesla (1856-1943) (16-16).
Proteins and most other bio-molecules are not at all a€?nonrigida€? structures; in order to fulfill their functions, they possess the ability to dynamically change their shapes within certain limits. Huge amounts of very tiny magnetic crystals (magnetite crystals) have been found in the brain, and these could react very sensitively to the slightest changes in magnetic fields (20). Even though in today's popular media, pseudo-scientific and quasi-medical reports on the topic of geopathy are presented to the public, no a€?peer revieweda€? medical journal indexed in MedLine had published statistically firm and sound provable evidence of geopathic effects on humans until most recently. Our first concepts how to address the geopathy phenomenon were based on the descriptions and personal discussions with the late Otto Bergsmann (a€  2004) and Alois Stacher (medical doctors, both from Vienna, Austria) and carried out in close co-operation with Adolf Wiebecke and his team (Salzburg and Oberalm, Austria). For detection geopathic stress, we have followed the design of a randomized, double-blinded non-clinical trial (54-44), following the ethical guidelines of the expanded Helsinki Declaration (56). During the experiments, the complete GDV system was mounted on a trolley, in order to measure the effects of the two different zones in the laboratory room directly a€?on sitea€? without moving the test person to another place.
To gain reliable data, we paid careful attention to a number of issues influencing stability, reproducibility and safety (24, 30, 37, 45): Throughout the whole study, the very same GDV system was used.
As overlaying technical fields possibly influencing the results may have been present, we used sophisticated calibrated equipment to scan and record low and high frequency EMFs, potential acoustic noxae or vibrations during the whole study period, as well as a variety of additional physical parameters. Further analyses were carried out for complementary medical parameters included in the GDV software package. Those people who are already in the beginning stages of poor health may sense an added sensitivity for diseases of different kinds when staying longer on geopathic locations, as well as notice that healing processes may take longer than usual. As there are no reliable measuring instruments available so far, presently it makes sense to take advice from an experienced dowser. If constructional arrangements are not possible before erecting a building or before starting a reconstruction, which is supposedly the case in most instances, there are also other practical possibilities: provided that there is a will to do so, it should be possible to move beds or desk seats, in order to get them out of interference zones.
Everyone can do something to prevent negative influences by sources that cause stress: anything that lowers stress in general also helps one deal with specific stress factors, and zones, from any origin. Furthermore, many studies confirm that people who are a€?living healthilya€? a€“ who manage their weight, refrain from smoking, enjoy the outdoors, participate in sports, etc., - have stronger immune systems and feel definitely less stress than their a€?unhealthy livinga€? fellow men. For those who cannot (or do not want to) adopt many of the above mentioned choices, due to illness, age, or some other reasons, things could become more difficult.
Our studies show that it does matter on which location you stay for a longer period of time. What is the relevance of our findings for hospitals, convalescent homes and rehabilitation centers? The term a€?wellnessa€?, which is composed of the ideals a€?well-beinga€? and a€?fitnessa€? as well as a€?life-stylea€? and a€?happinessa€?, to a modern point of view denotes a holistic concept of health. In a pilot study (unpublished findings), we have found indications of more aggressive behavior by children living or working on geopathic locations. Naturally, the negative effects of geopathic stress zones also have considerable commercial impact. The follow-up costs associated with longer a€?chronica€? stays on geopathic interference zones are probably enormous: As said before, geopathy is a matter of a€?burdened work placesa€? leading to decreased ability of the employees to concentrate and to increased probability of employees' illnesses. So far, the present scientific evidence of effects of geopathic zones on humans has been mainly found using complementary medical methods, with the exception of the GDV a€?area-of-glowa€? parameter.
At the same time, we have already started experiments above different geological zones to test such key parameters contained in saliva, using biochemical assaying well accepted by orthodox medicine: various hormones, neuropeptides and immunological relevant substances are going to be tested a€?non-invasivelya€?. The authors extend thanks for their great help in conducting the quoted research and its essential components to this manuscript.
For their innovative and far-seeing pioneering work and active scientific exchange in the field of geopathy we thank Univ.-Doz. When it comes to the topic of earth radiation, water veins and earth dislocations a€“ the so-called geological disturbances a€“ the layperson will usually associate this with hocus-pocus concepts such as a€?Dowsers,a€? often a man with large whiskers and an ironic smile. Many people do not believe the dowsera€™s tale, and associate it with occult illusion a€“ even if successes have been reported simply by moving a bed to a different area of the room.
The most common reason for the prejudice of the person listening -- who generally considers himself to be moderna€?and intelligent -- is the fact that nowhere do we find soa€?many absurdities, contradictions and a€?silly thingsa€? as in this area. Ten allegedly qualified dowsers generally come to ten different conclusions in the same apartment or building.
I am sickened when I am told how people play tricks with the fears and hopes of seriously ill individuals. I hope to make a contribution in this area so that we may have an objective discussion of this subject. For years, sensitive electronic measuring devices have verified the old knowledge about earth radiations. You can actually measure the natural radioactive radiation from the earth, all over the globe. We are born amid these natural manifold-radiating processes and there is no doubt that they are appropriate, important, healthy, and life protecting.
But there are also zones (areas) where radiation intensities are noticeably different from the norm.
I might measure a level of radiation along a long-line, for example, and often the intensity will change suddenly, giving me an entirely different value. Sometimes these higher intensity zones area€?frequent and can be detected every other yarda€?or so. It is interesting to note that gifted dowsers will show swinging of rods or pendulums exactly where you would measure these significant anomalies too.
I do not like to define, prematurely, every swing of a rod by a gifted dowser or every measured peculiarity as a a€?water veina€? or a a€?dislocation.a€? I have never dug into the ground to find the object which I assumed to be in existence while I was measuring on top of the ground. It is the task of science to connect one thing with another, and to analyze these connections.
My practical experience is sufficient for me to know that concentrations of terrestrial radiation can be measured, and the findings will show noticeable differences from natural points of reference in the natural environment. What do we really measure, with our sensitive electronic instruments, if the objects are earth radiation, geological disturbances, water veins and dislocations?
I refer to my own personal experiences, with different measuring approaches, and do not pretend exclusiveness. That means: when you are above geological disturbances you can measure the distortion of the terrestrial magnetic field, similarly to that of magnetic steel.
Here the compass is not the appropriate device because the declinations are so small that they cannot generate any substantial swing. This measurement approach is not appropriate for house and bedroom examinations, however, because the artificial distortions coming from steel used in construction, materials, metal fixtures, and even the bed itself, can cause a blur in the measurement or make a reading entirely impossible. I think the argument is exaggerated; that these anomalies of terrestrial magnetic fields above geological disturbances are sufficient to cause biological problems. Conclusion: Though you can measure geological peculiarities, the application a€“ in rooms a€“ is rarely reliable. A second peculiarity, as far as earth radiation is concerned, is that air ions often change. Ion measurements are extremely difficult and ambiguous since many factors in your house mix up the air ions even more than the terrestrial radiation is capable of.
This measurement is just impossible under the influence of an electrically radiating wall, or an electrostatically loaded curtain.
I have discovered that a plastic bag, within a five-yard distance of the measurement, can change the environment of the air ions more radically than what could be possible from the geological subsoil. Measurements of the VHF field strength often show a drop in the measurement curve when taken above disturbances. Within buildings, however, evaluations are almost impossible as the measurements within walls are highly unreliable. One has to be very critical and attentive so as not to be taken in by too rash and incorrect conclusions.
Many manuals say that locating geological disturbances by using the VHF field strength is childa€™s play. The geo-rhythmogram measures the skin resistance of a person from hand to hand with simple electrodes and a fitting ohm-meter. When the skin resistance of a test person is normal, at 40 kilo ohm (Aschoff), the values can go up to 100, 200, or even higher when you are above zones of disturbance. Even when all pre-conditions are fulfilled some problems remain: All stimuli towards the test person will be included into the measurement. Only with enough experience can you relate anomalies of the skin resistance to geological stimuli, and totally exclude that they are not produced from radio alarms or a spring mattress.
If you can do that, then the physical measurement can be reproduced and give a reliable result.
Particularly interesting is the fifth possible approach to measuring terrestrial radiation. That means: As I measure the natural radioactive radiation with a sensitive radiometer, I will get values of 100 percent or more if the measure is above a so-called disturbance zone. Though the natural basic radioactivity of the earth has some local differences due to climate and the earth level, the base level is generally consistent.
From my experience, regular and reproducible increases in radioactivity above geological stimuli areas, in the range of up to 100 percent, are profound and are significant. If you can sleep for the next 20 years with only half the amount of radioactive disintegrations -- after a change of the bedroom position a€“ then, as a matter of caution, I see no reason to stay in the area that is doubly charged. I think it is greatly exaggerated to speak rashly of a€?cancer zonesa€? if you are referring to terrestrial radiation and other corresponding peculiarities.
According to my own personal experience, and the findings of innumerable research and test reports, the healing successes after moving the bed cannot be discounted merely as psychological reaction placebo or coincidence.
During a meeting in Seattle, USA, I detected this phenomenon in a 22 floor hotel, on six different levels: in the underground garage, at the first floor near the reception, and on the roof -- always the same high values, down below and at the top, on the same premises.
As you know, I have found houses in which the radioactive radiation was higher than that which could be found in playgrounds and public swimming pools near the Chernobyl accident.
The reason for this is radioactive construction materials: cinders, ashes, chemical gypsum, tiles, pumice and metallurgical stones -- all sorts of possible and impossible industry waste.
Additionally, certain antiques, minerals and glazes a€“ in direct range of your body a€“ can radiate so strongly that biological risks can become immense. While visiting three patients with brain tumors, I found just beside the head of one person a very old alarm clock that was radiating radioactivity; with another, a dark green glazed image of St. For measuring terrestrial radiation, I use my most expensive instruments: highly sensitive scintillation counters. My experiences with measurements of radioactivity soon led to the decision to build a measuring device especially well-suited for building, biological, and geo-biological work, and one that was constructed to my own specifications. The very high sensitivity of the third prototype convinced me: more than 250 impulses per second in a normal radiation background, and more than 500 impulses per second on geologically disturbed surfaces. Besides its extreme measuring preciseness, the scintillation counter has the particular advantage of being extremely sensitive to gamma rays.
With his super-sensitive measuring device (of more than 1,000 impulses per second!), he has shown that you can find water from the ground surface - guaranteed.
More than 35 years of experience makes it possible for Stangle to define, with his measurements, the exact depth, the amount a€“ to the very gallon -- the mineralization, and the temperature of the localized water.
The Daimler-Benz company made five expensive unsuccessful drillings before they called Jakob Stangle with his scintillation counter. In 1972 Jakob Stangle walked through Vilsbiburg with his scintillation counter and totally confirmed the work of his sensitive predecessor by exact measurements, in two absolute blind tests. An architect intended to buy and renovate a large villa at the Baldeney Lake in Essen, Germany. Another time, a doctor recommended to the manager of a concert agency to have her home examined by me.
She also looked into the geological maps and found the disturbance was mapped by the Krefeld agency.
After these results, I bought several geological maps from North Rhine Westfalia, Germany, and checked ten plotted geological disturbances with my measuring devices. Styrt B, Gorbach SL: Recent developments in the understanding of the pathogenesis and treatment of anaerobic infections.
Summanen P, Baron EJ, Citron DM, Strong CA, Wexler HM, Finegold SM: Wadsworth Anaerobic Bacteriology Manual. Group D (enterococci and non- enterococcal strains) Diseases Urinary tract infections - associated with manipulations, malignancies, biliary tract disease & GI disorders Urinary tract infections - associated with manipulations, malignancies, biliary tract disease & GI disorders Wound and soft tissue infections Wound and soft tissue infections Endocarditis - bacteremia associated with lon-term indwelling intravenous catheters Endocarditis - bacteremia associated with lon-term indwelling intravenous catheters S.
Epidemiology of Streptococcus Natural habitat Natural habitat ? Group A, pneumococci and viridans strept - upper respiratory tract of humans ? Group A, B, and D - vaginal ? Group B and D – intestine Transmission Transmission ? Direct contact with mucosa or secretions ? Aerosols - droplet produced by coughing, sneezing, talking ? Indirect - fomites (shared inanimate objects) ? Insects, esp.
Community-acquired pneumonia refers to pneumonia acquired outside of hospitals or extended-care facilities.
Among the most likely candidates are Bacillus anthracis, Francisella tularensis, and Yersinia pestis.
However, there is an increased influence of pathogens seen with relatively low frequency in the community, such as S.
Inhalation of infectious particles is probably the most important pathogenetic mechanism in the development of community-acquired pneumonia, with particular importance of pneumonia caused by Legionella species and M. Swallowing and epiglottic closure may be impaired by neuromuscular disease, stroke, states of altered consciousness, or seizures. Hematogenous deposition of bacteria in the lungs is also uncommon but is responsible for some cases of pneumonia caused by S.
Pathogens such as Pneumocystis jiroveci, Mycobacterium tuberculosis, and cytomegalovirus can remain latent for many years after exposure, with flares of active disease occurring in the presence of immune compromise. The cough reflex can be impaired by stroke, neuromuscular disease, sedatives, or poor nutrition. For example, granulocyte chemotaxis is reduced with aging, diabetes mellitus, malnutrition, hypothermia, hypophosphatemia, and corticosteroids. A diligent history (Table 3) and physical examination can help narrow the differential diagnosis. This can be distinguished from other viral infections by the higher fever and lack of conjunctivitis, sneezing, rhinorrhea, and pharyngitis.
Older patients often have humoral and cellular immunodeficiencies as a result of underlying diseases, immunosuppressive medications, and the aging process.
Poor dentition and foul-smelling sputum can indicate the presence of a lung abscess with an anaerobic component.
Health care budgetary constraints have given rise to a number of studies addressing the need for hospitalization in community-acquired pneumonia. Those in classes I and II are considered excellent candidates for outpatient oral therapy, assuming no hemodynamic instability, no chronic oxygen dependence, immunocompetence, and the ability to ingest, absorb, and adhere to an oral regimen. When identification of a pathogen might change therapy, further studies are indicated (see Box 1). Unfortunately, sputum is often difficult to obtain from older patients because of a weak cough, obtundation, and dehydration. Direct fluorescent antibody (DFA) staining of sputum, bronchoalveolar lavage fluid, or pleural fluid can help identify Legionella species. Culture is particularly helpful for identifying organisms of epidemiologic significance, either for patterns of transmission or resistance. Pleural or cerebrospinal fluid should be sampled when infections in these spaces are suspected. Fiberoptic bronchoscopy allows the use of several techniques for the diagnosis of pneumonia. Because these procedures can carry considerable morbidity, they are usually reserved for the deteriorating patient with a pneumonia that defies diagnosis by less-invasive techniques. A number of expert panels have recommended empirical pneumonia therapy, most prominently IDSA and ATS (Table 8). Many antibiotics are well absorbed from the gastrointestinal tract, suggesting the possibility of effective fully oral treatment. Side effects are rarely serious and consist of local pain and erythema, which occur in up to 50% of recipients. Measures to prevent the spread of SARS-associated coronavirus include close attention to cough hygiene, hand hygiene, contact precautions, and respiratory droplet precautions.
The most often cited are the guidelines of IDSA and ATS.2 Thoughtful and comprehensive, these guidelines provide recommendations for the evaluation and treatment of the patient with community-acquired pneumonia driven by data, when available. Compromise has been reached between the two organizations regarding the diagnostic evaluation of community-acquired pneumonia. In such situations, the websites of the CDC, World Health Organization, IDSA, and state and local health departments often contain updated authoritative information and guidelines to assist the practitioner. Among the measures adopted are assessment of oxygenation, screening for pneumococcal vaccination, blood cultures before first antibiotic dose, assessment for smoking cessation, antibiotics within 4 to 6 hours of arrival at the hospital, and correct choice of antibiotics.
Guidelines for the initial management of adults with community-acquired pneumonia: Diagnosis, assessment of severity, and initial antimicrobial therapy.


Update: Investigation of bioterrorism-related anthrax and interim guidelines for exposure management and antimicrobial therapy, October 2001.
Duration and route of antibiotic therapy in patients hospitalized with community-acquired pneumonia: Switch and step-down therapy.
Prevention and control of influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Prevention of pneumococcal disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). If you continue to stay in these areas especially during sleep, then in the long term the stresses on our bodies will emerge as more serious conditions such as, diseases of the central nervous system, Multiple Sclerosis (MS), Chronic Fatigue Syndrome (CFS), miscarriages, and cancer.
Not only are the public more generally aware, but their governments funds aid and continuing research in to the matter. Geopathic Stress is only one of them and it is becoming more difficult to gauge especially when the natural energy field is constantly changed and amplified by man-made electromagnetic fields. The phenomenon has been linked to insomnia, migraine, headaches, loss of balance, short -term memory loss, joint pain, cot death, infertility, miscarriages, Chronic Fatigue Syndrome (ME) and cancer. It has been known for a long time that when there is flowing water under a dwelling the inhabitants always feel more tired, are prone to premature aging and have a loss of vitality than those who sleep above neutral ground.
I have the original 134 page research document in German and a badly translated version in English. These pathogenic locations defined in the report as, a€?earth radiation's evoked by a discontinuity of the normal physical parameters on the surface of the earth,a€™ and shortened to a€?Disturbed Zonesa€™ are the subject of the research. Such locations have been termed in China and many European countries as either a€?curseda€™ or a€?cancera€™ houses. The functioning hypothesis of the research was that geophysical characteristics of the surface of the earth are not uniform and that location dependent influences exist that can have a detrimental effect on both human and plant biochemical systems. They were enlisted to independently dowse eight different locations and submit reports and diagrams of the strongest a€?Disturbed Zonesa€™ found, together with a a€?Neutral Zonea€™ at the same location to enable them to carryout double blind experiments with volunteers at each selected location. Technology does not yet exist to do this the other way round; the dowser does not yet appear to be replaceable with scientific instrumentation. However because of the high standard of the research only significant results were accepted. The stereotypical result on the a€?Disturbed Zonea€™ was deterioration of the electro-biological functioning in the sense of depression or blockage of bioelectric functions. In the 15 minute time exposure on the a€?Disturbed Zonea€™ the results remained under the significance barrier.
An apparatus able to discriminate such low energy broadband EMFs from noise apparently is not yet available.
Both, technical and biological systems can be influenced by EMFs, whereby numerous questions are still open, such as the concerning limits and the nature of physical interference fields (5).
As an extremely dielectric medium, water favors the formation of potential vortices, which immediately after their formation contract swiftly.
In nature, piezoelectrical dischargings can occur in some areas of geological a€?warpsa€? containing quartz sand particles, and may be another plausible cause of geopathic stress effects (14). When a crystal lattice cell is compressed by mechanical pressure, an imbalance is the result, manifesting itself in the development of a tiny electrical voltage (Fig.
In spite of the fact that scalar waves in the field theory of Maxwell are usually neglected and set to zero, numerous experiments can lead to the conclusion that they do really exist and influence the human organism (5).
The presence of pure physical interactions and in addition also of a€?physiologic sensorsa€? located inside the body can be assumed. Physical resonance is defined as a synchronization of two sources which vibrate with the same pulse frequency but with contrary polarity. Internal protein dynamics can potentially affect protein function through a variety of mechanisms, some of which are tautological or obvious in nature while others are subtle and remain to be fully explored and appreciated (18). Black dots on magnetic resonance imaging pictures (MRI) of human brain tissue led researches to the idea that these could be magnetic particles. Evidence that these microscopically small magnetite particles would function for some kind of sensory perception in humans could not yet been confirmed. Previously described effects and descriptions of the pioneers (1, 3 and others) in this area unfortunately arena€™t available in the standardized, scientifically acceptable nor reproducible format required for peer-reviewed medical journals, but rather as monographs. Because of the lack of a€?directa€? physical measurement techniques for the doubtlessly existing a€zenergy fieldsa€? at least partly originating in the ground, we decided to use the human body as an indicator.
Being fascinated by its highly sensitive ability to detect stress effects, and also by the fact that this method is being used world-widely for manifold applications combining a€?pure physicsa€? with complimentary evaluation of apparently high accuracy, we could reproducibly show using this method that different zones above ground do exhibit different effects on the human organism. In addition to the promising data presented in numerous publications before, including our own, we are presently in the middle of an evaluation targeting a validation of GDV mean area-of-glow as a reliable measure of certain aspects of stress. All test persons had been informed about the GDV system and related safety issues, and about the fact that they may feel a slight a€?crawlinga€? in their finger tips. In practice, to capture one a€?static GDV imagea€?, a very stable high voltage (10 kV, 1.024 Hz, square pulses) is pulsed on and off every 10 ms for a duration of 0,5 s.
For each test person and test phase, 50 single static measurements were performed (each finger tip was measured 5 times for 0,5 s). Before use, the GDV camera (kept inside the laboratory at constant room temperature) was switched on at least 30 minutes prior to measurement, and careful calibrations were performed.
In addition to the calculation of descriptive data (mean, median, standard deviation etc.), we carried out Gaussian normality tests and subsequently used the paired two-sample t-test for dependent variables to determine whether there are significant differences between the 4 experimental sub-period results.
The two measurement areas in the laboratory used for the experiments turned out to be indistinguishable from the aspect of technical fields and acoustic background noise, and the field strength and loudness levels present were far below existing (safety) guidelines. Statistical significance again was enormously high (p < 0,0001) when compared to the results on those zones without the a€?Wavea€? device (24). In later stages, it my not be impossible though that chronic stress caused by geopathic locations may finally even forward the development of malignant disease.
However, according to the Munich barn-experiments (66-68) and other independent investigations, only a low percentage of the people claiming to be successful dowsers are actually capable of making reproducible and reliable conclusions. This includes methods of stress-management and relaxation techniques, such as meditation, tai chi, guided imaginative journeying, and also certain hypnotherapeutic approaches (69-73). Para-scientific reports about sleeplessness or higher rates of occurrence of different diseases have been with us for many years. In hospitals, observant physicians and nurses sometimes know from experience that there appear to be locations of sickbeds where, remarkably, many patients have a delayed recovery, or in especially blatant cases they may not recover at all. Wellness enhancing methods and applications aim to increase physical, psychological and spiritual well-being.
Individual performance on a€?interference reduceda€? zones increases, and all sides - superintendents, managers and employees - would possibly benefit. This can produce enormous costs for our social and health systems, and the hidden costs we can only suspect today.
As preliminarily presented in this book, we have already obtained data underlining the validity of GSV as a reliable instrument for measuring stress, provided that all pre-cautions are taken into account and that well-trained and experienced persons use it.
Adolf WIEBECKE (Oberalm bei Salzburg), whom we want to congratulate for his most promising invention of the a€?Wavea€? device, for the possibility of doing experimental research using his device. Seidel P, Schmidl F, Becker C, Springborn U, Biering S, Grosse V, FA¶rster T, Lorenz P, Bechstein R: Planar high-temperature superconducting dc-SQUID gradiometers for different applications.
Hong R, Zhang Y, Liu Y, Weng EQ: Effects of extremely low frequency electromagnetic fields on DNA of testicular cells and sperm chromatin structure in mice.
Chen P, Yang YQ, Tao HH, Yang HC: Effects of electromagnetic fields of different frequencies on proliferation and DNA damage of gallbladder cancer cells.
Nylund R, Leszczynski D: Mobile phone radiation causes changes in gene and protein expression in human endothelial cell lines and the response seems to be genome- and proteome-dependent. Grassi C, Da€™Ascenzo M, Torsello A, Martinotti G, Wolf F, Cittadini A, Azzena GB: Effects of 50 Hz electromagnetic fields on voltage-gated Ca2+ channels and their role in modulation of neuroendocrine cell proliferation and death. Hecker R: Emission elektrischer und magnetischer Signale von Gestein infolge A¤uAYerer mechanischer Belastungen.
Baureus Koch CL, Sommarin M, Persson BR, Salford LG, Eberhardt JL: Interaction between weak low frequency magnetic fields and cell membranes. Mathie A, Kennard LE, Veale EL: Neuronal ion channels and their sensitivity to extremely low frequency weak electric field effects.
Dobson P, Oa€™Keefe E: Investigations into stress and its management using the gas discharge visualization technique. Russo M, Choudhri AF, Whitworth G, Weinberg AD, Bickel W, Oz MC: Quantitative analysis of reproducible changes in high-voltage electrophotography. Bascom R, Buyantseva L, Zhegmin Q, Dolina M, Korotkov K: Gas discharge visualization (GDV)- bioelectrography. Korotkov KG, Popechitelev EP: Method for gas discharge visualization and automation of the system of realizing it in clinical practice. Treugut H, Gorner C, Ludtke R, Schmid P, Fuss R: Reliabilitat der Energetischen Terminalpunktdiagnose (ETD) nach Mandel bei Kranken. Medvedev SN, Mala€™tseva AS, Popkova AM, Serov VV, Igonina NP, Tkacheva OI, Kozin AN: Possibilities of the use of Korean acupuncture Su Jok in the clinical practice. Kato M, Honma K, Shigemitsu T, Shiga Y: Circularly polarized 50-Hz magnetic field exposure reduces pineal gland and blood melatonin concentrations of Long-Evans rats. Burch JB, Reif JS, Yost MG: Geomagnetic disturbances are associated with reduced nocturnal excretion of a melatonin metabolite in humans. Jajte J, Zmyslony M: The role of melatonin in the molecular mechanism of weak, static and extremely low frequency (50 Hz) magnetic fields (ELF). Torpy DJ, Chrousos GP: The three-way interactions between the hypothalamic-pituitary-adrenal and gonadal axes and the immune system.
This often results in the purchase of expensive screening and de-jamming devices, for which only the unreliable producer and distributor gets any profit. We all know that the earth a€“ in fact, all of life a€“ a€?radiatesa€? as a natural process.a€?There exists a strong terrestrial magnetic field, which guarantees that the top of a compass is always drawn to the north, no matter where you are in the world. It has been known for a long time that underground watercourses and geological dislocation produce spectacular radiation intensities.
Sensitive magnetometers can, however, easily make these distortions visible and can be defined as biologically effective by experts. This method is only justified when you know that artificial fields, from say a€“ magnetic steel, are not in the area. That is hardly possible because the magnetic field of some spring mattresses equals more than a hundred water veins. The importance of these findings to the area above the disturbance is very much in dispute. The results of these unqualified statements are that credulous laymen go over their bedrooms with a 30 dollar portable radio and assume there are water veins (and other phenomena of terrestrial radiation) whenever NBC or ABC gets bad reception, or a song by Elvis is jammed by noise. The much more exact electro- geobioscopy measures the skin resistance between one hand and acupuncture points on the other hand. You should consider however, that every response of a human being to the stimuli of his environment is a specific one, ita€™s individual, and cannot be easily transferred to others. This radioactive electromagnetic radiation is considered the most penetrating, strongest and biologically most hazardous kind of all of the known radioactive rays. But no onea€?can deny that an avoidable risk exists undera€?long-term influence, such as sleeping every nighta€?for eight hours in the same physical position, and doing that for many years.
Regardless of the kind of radiation, no sensible scientist dares to contradict this opinion. For measuring construction material, I use proportional and Geiger-Muller-counter tubes, and xenon-large-area detectors.
The rays are converted into light flashes, boosted as electrical impulses via a photo-multiplier and then calculated and displayed by sophisticated electronics.
Wust had already reported about measurements of gamma rays at a€?geopathic zones.a€? The scientists, physicists and doctors Williams, Weber, Cody, Lorenz and Bickel (the last one from California) had made similar successful experiments. He, more than anybody else, has shown that there is a relationship between subterraneous water sources and ionizing radioactive radiation. All bells rang when the drilling machine cut the granite crack 500 yards below a€“ out of which the curative water came. There turns out to be significant relationships between these zones and cancer patients of the town, as they were sleeping exactly above these zones. My measurement of the radioactivity, with the scintillation counter, showed a 12-yard wide disturbance that could be detected in the whole house, outside the building, and in the nearby yard. He found there was indeed a water-bearing dislocation, which was officially plotted on two geological maps made in 1911 and in 1980. In all cases, my scintillation counter showed, for hundreds of yards, values that were well above average. A service of the National Library of Medicine, National Institutes of Health.Baron S, editor.
General Characteristics of the Staphylococci Nonmotile, gram- positive cocci arranged in irregular clusters.
Nursing home–acquired pneumonia refers to infection acquired in an extended-care facility. Other pathogens have been reported to cause pneumonia in the community, and their order of importance depends on the location and population studied (Table 1).
Cases of transmission from birds to humans with severe disease have led to international concern about a possible avian influenza pandemic. Endotracheal and nasogastric tubes interfere with these anatomic defenses and provide a direct route of entry for pathogens.
Mucociliary transport is depressed with the aging process, tobacco smoking, dehydration, morphine, atropine, prior infection with influenza virus, and chronic bronchitis. Inhalation anthrax can manifest with flulike symptoms of myalgia, fatigue, and fever before rapidly progressing to respiratory distress, mediastinitis, meningitis, sepsis, and death. They are more commonly institutionalized with anatomic problems that inhibit the pulmonary clearance of pathogens. A study by the Patient Outcome Research Team (PORT) investigators has validated a risk scale, now called the pneumonia severity index (PSI), for mortality in community-acquired pneumonia. Patients in risk class III may be considered for outpatient or brief inpatient therapy, depending on clinical judgment. Similarly, DFA testing of nasopharyngeal specimens provides rapid diagnosis of influenza types A and B, as well as other common respiratory viruses such as respiratory syncytial virus, adenovirus, and parainfluenza virus. Expectorated morning sputum specimens should be sent for mycobacterial culture when the history is suggestive. Bronchoalveolar lavage with saline can obtain deep respiratory specimens for the gamut of stains and cultures mentioned earlier. A fourfold increase in the immunoglobulin G (IgG) titer suggests recent infection with these organisms.
Because the antigen persists for up to 1 year after infection, it is difficult to differentiate between past and current infections when using this assay. This assay may offer some advantage for the rapid diagnosis of pneumococcal pneumonia in culture-proven or unknown cases, but assay specificity is an ongoing question.
When large-volume aspiration is documented in the hospital, a beta-lactam–beta-lactamase inhibitor combination or the combination of clindamycin and an antipseudomonal agent should be used.
Because well-controlled, risk-stratified data comparing oral and intravenous therapies are few, appropriate patient populations and treatment settings for full-course oral therapy have yet to be fully defined.
Entities such as cancers, pulmonary edema, pulmonary embolus, pulmonary hemorrhage, connective tissue diseases, or drug toxicity can mimic the clinical and radiographic appearance of pneumonia. The CDC recommends that vaccines be offered to all persons 65 years of age or older, those at increased risk for illness and death from pneumococcal disease because of chronic illness, those with functional or anatomic asplenia, and immunocompromised persons.16 Patients who are immunosuppressed by chronic disease or treatment might not have sustained titers of protective antibody and should be considered for revaccination after 6 years. Recommendations are classified by strength of supporting data; recommendations formed on the basis of opinion rather than data are identified.
Concerns of drug resistance and epidemiologic tracking have been noted, as have been concerns about lack of sensitivity and specificity in microbiologic testing. While we are asleep our body should be resting so it can repair body cells, fight infections and absorb nutrients from food. In some schools children are moved at frequent intervals to avoid possible harmful effects. If geopathic stress is suspected, it makes sense to move away from the source or to think about dealing with the threat. Women are more likely to be at risk from geopathic stress because their hormonal systems are more susceptible. While water running beneath a domestic dwelling should be avoided, a stream situated nearby and open to the sky will favourably discharge its negative energies harmlessly into the atmosphere. The aim of the report is to establish whether these a€?Disturbed Sitesa€™ can produce statistically significant results to support the high degree of topicality the phenomenon is having in both main stream and alternative medical practices. A number of these were rejected when illnesses (circulation interference and infections) were discovered. Three silver electrodes were used placed on the forehead, palms and soles; a microprocessor based unit automatically produced the results. All measured parameters gave reference to location dependence with the integral rake size for Systolic ventricle work showing significantly different behaviour.
It was thought however, that if the experiment allowed further time exposure the investigation may have achieved a significant result. The Biometric analysis showed that on the a€?Indifferent Zonea€™ the pulse-breath quotient remained in balance but was significantly affected on the a€?Disturbed Zonea€™. One of the main functions of Serotonin is to act as a neurotransmitter in the parasympathetic system which controls energy provision.
Gernot PAUSER: University Clinic for Anesthesiology, Perioperative Medicine and General Intensive Care, Landeskrankenhaus Salzburg, University Clinics of the Paracelsus Private Medical University, Salzburg Federal Clinics (SALK), Salzburg, Austria. A recent technological innovation can now aid us in this quest, allowing a sophisticated physical measurability of deviations of the earth's magnetic field: the SQUIDa€“technology. In addition to the discussed weak, broadband transversal electromagnetic and magnetic fields assumed to be originated in the ground, other forms of a€?energiesa€? might exist, such as the often controversially discussed longitudinal scalar waves (5). There is growing experimental evidence that EMFs - at least those of technical origin a€“ can have significant effects on cells and the entire organism. If you turn a water molecule with its electric charge distribution, then from the moving charge a magnetic field results.
The effect was already discovered in 1824 by David Brewster and then experimentally elaborated by Pierre and Jacques Curie in 1880. According to Professor Konstantin Meyl (Furtwangen University, Germany), to a measurement technician scalar waves experimentally manifest as (antenna-)noise, a mixture of frequencies and wavelengths.
However, an extensive discussion of the origin and effects of radioactivity from the ground would go far beyond the scope of this manuscript. In the case of resonance, information is being exchanged, energies are transmitted and, in fact, a component of balance between the sources is being formed (from personal communication, A.
Certain processes of proteins as parts of their 3-D conformation have the ability to oscillate or rotate. From post mortem brains, magnetite crystals of a size of 50 nm could be isolated, and their magnetic field could be measured. However, speculations are that the presence of magnetite crystals in brain might be understood as proof of a a€?submerged magnetic sensora€?, similar to that of carrier pigeons or whales, theoretically easing human orientation and direction a€“ thus a kind of a€?relict of evolutiona€?. Nevertheless, this doesna€™t lower their importance and relevance: Those pioneers in research on the geopathy phenomenon neither had the scientific-medical verifiability methods that are available today, nor was the time mature for such publications in the kind of medical journals we know today.
In our first approaches, we utilized methods from complementary medicine (bio-resonance, kinesiology, heart-rate variability, etc.).
Petersburg, Russia), as used in that work, delivers a number of sensitive and reproducible parameters (25-46).
Although not yet completed, our tests appear to show that this is indeed the case: Parallel measurements of the diurnal time courses of GDV mean area of glow and of biochemical parameters collected from saliva (50-53) indicate that the diurnal curve progressions of GDV image areas and the levels of immunoglobulin A (IgA) go parallel, whilst another accepted parameter of stress, saliva alpha-amylase, progresses just the opposite to IgA and GDV. Fifty-two voluntary test persons were measured at two locations, one of which has been identified by a group of six distinguished dowsers as being a a€?geopathic zonea€? and the other a a€?neutral zonea€?. The electric field produces a visible gas discharge glow around the fingertip (Kirlian image), and such corona discharges have been recorded from each of the 10 fingertips of the test person repeatedly. In addition, we have recorded dynamic GDV images from both ring fingers, repeated 3 times during each test period. Each test person was asked to thoroughly wash their hands using a pH neutral laboratory soap (without re-fattening properties), followed by wiping the fingertips with alcohol. From the results of our studies it can be concluded that geopathic zones do cause stress in nearly all of the persons tested.
Such zones might cause distress (a€?malignant stressa€?) even when present for a short time, but there are also reports that (not scientifically proven) energetically stimulating zones (a€?positive energy zonesa€?) might exist, often also referred to as a€?power placesa€?. During the planning stage in construction of new buildings, the geopathy phenomenon should be taken into account, so as to consciously design and construct buildings and rooms in a manner that, in areas where people will stay for longer periods of time, geopathic exposure should be as low as possible. Therefore it makes sense to consult with a competent building environment engineer who has experience, skill and expertise in these matters. Interestingly, these positive lifestyle choices may also show up indirectly and in the subconscious: even technically derived EMFs seem to have much less of a negative effect with people who prefer such an a€?awarea€? way of life. It is clear that the accumulation of different factors stress can have strong effects on humans, animals and even plants. One of the tests, taken in a care center for children displaying behavioral problems, additionally showed, among other changes, that the incidence of bedwetting [nocturnal enuresis] definitely decreased when the a€?Wavea€? was present, and that the learning ability and the quality of sleep changed for the better (unpublished findings).
A serious athlete who doesna€™t sleep well before a competition is far from being as able-bodied as someone who has had a€?a good night's resta€?. When individuals feel better, they will perform better, and be healthier and happier at work too a€“ facts that would also have economic consequences. Parameters measured in saliva in parallel to GDV, such as IgA, alpha-amylase and cortisol, appear to change in level in direct relationship to the GDV mean area of glow. From an extended vortex and field theory to a technical, biological and historical use of longitudinal waves. Their findings usually provide shockingly different interpretations of the biological effects of natural conditions. Once I move past this zone, the striking radiation intensity can decrease, giving me a a€?normala€™ value again.
In all three cases, the radioactivity coming from these items were several times higher than the law allows for workers in nuclear power plants a€“ and for a short period of time only. Some of the well- known mineral waters exist only because he found their origin deep in the earth.
They found water, which had the prophesied 17 degree hardness, and which flowed abundantly. They are the most common anaerobes involved in infection and include some of the most antibiotic-resistant species.Structure, Classification, and Antigenic TypesSome are pleomorphic, whereas others have distinctive morphology. Clinical ManifestationsGram-negative anaerobic bacilli may cause infections anywhere in the body; the most common types are oral and dental, pleuropulmonary, intra-abdominal, female genital tract and skin, soft tissue and bone infections (Table 20-1). Nosocomial pneumonia and hospital-acquired pneumonia describe infections acquired in the hospital setting. These include long-recognized pathogens such as Haemophilus influenzae, Mycoplasma pneumoniae, and influenza A, along with newer pathogens such as Legionella species and Chlamydophilia pneumoniae. Impaired lower esophageal sphincter function and nasogastric and gastrostomy tubes increase the risk of aspiration of gastric contents. The direct extension of infection to the lung from contiguous areas, such as the pleural or subdiaphragmatic spaces, is rare.
Anatomic changes such as emphysema, bronchiectasis, and obstructive mass lesions prevent the clearance of microbes. Alveolar macrophages are rendered dysfunctional by corticosteroids, cytokines, viral illnesses, and malnutrition. The presentation is often more subtle than in younger adults, with more-advanced disease and sepsis, despite minimal fever and sputum production. Also, the radiographic manifestations of chronic diseases such as congestive heart failure, chronic obstructive pulmonary disease (COPD), and malignancy can obscure the infiltrate of pneumonia. Point values are assigned to patient characteristics, comorbid illness, physical examination, and basic laboratory findings (Table 5).8 Patients younger than 50 years without comorbid illness or significant vital sign abnormalities (risk class I) were found to have a low risk for mortality. However, pathogen identification has important implications for the breadth of therapeutic antibiotic spectrum, development of resistance, and epidemiology.
Nasotracheal suctioning can sample the lower respiratory tract directly but risks oropharyngeal contamination.
In an outbreak setting, DFA and other rapid techniques can assist in decision making for therapy and infection control. Transbronchial biopsy of lung parenchyma can reveal alveolar or interstitial pneumonitis, viral inclusion bodies, and fungal or mycobacterial elements.
The resulting recommendations minimize testing for uncomplicated cases of pneumonia, allowing more extensive testing for sicker patients. However, if we sleep in an area affected by geopathic stress, our body has to use all its energy just to keep its vital organs going. Reports from other countries such as Switzerland, France, the Netherlands, Belgium and Scandinavia indicate that they too have been taking notice.
Geopathic stress - or harmful earth rays - is natural radiation that rises up through the earth and is distorted by weak electromagnetic fields created by underground streams, certain mineral concentrations and fault lines. Foresight, the pre-conception care organisation, even suggests that couples trying for a baby should get their homes checked for geopathic stress and ensure that electrical equipment is not located under their beds as this can cause electromagnetic stress and deplete the immune system.a€?For many of us who fall sick and seek the help of a doctor a few minutes is spent discussing symptoms and lifestyle quickly followed by the doctor scribbling on a proscription pad. In order to rule out possible influences of man made electromagnetic or microwave disturbances at each location an independent report from an electromechanical engineer was requested for each chosen site. Other participants were also used from the Outpatients Department for Physical Therapy in the Rehabilitation Centre, Grobming and from the Surgery of Dr. This deterioration of the HFR was thought to be due to a€?Location loada€™ from the a€?Disturbed Zonea€™. Hacker: Head, IGGMB - Research Institute for Frontier Questions of Medicine and Biotechnology, Landeskrankenhaus Salzburg, University Clinics of the Paracelsus Private Medical University, Salzburg Federal Clinics (SALK), Salzburg, Austria.
In recent years, the expressions a€?geopathic stressa€? and a€?geopathic interference zonesa€? have been accepted internationally to describe the phenomenon. At present, for most aspects contained herein, only hypotheses can be formed - and there are many of them. With Super-Conducting Quantum Interference Devices (SQUID), it is possible to quantify variations of one ten billionth [American English] of the earth's magnetic field.
Certain ions and metals moved by water can a€“ depending on concentration, composition and flow rate a€“ can indeed lead to geoelectricity.
If thus in a pipe a hydrodynamic flow vortex is produced, an electric and a magnetic vortex, the potential vortex and the eddy current, are the result (5). Although also present in tourmaline, topaz, cane sugar and Rochelle salt (sodium potassium tartrate tetrahydrate), the effect became particularly known for quartz.
Vice versa, quartz can be triggered to oscillate by applying a voltage to it (a€?quartz oscillator crystala€?; in use for example in crystal controlled clocks). In the case of plasma waves, they are charged particles, and in the case of sound waves, they are air particles.
Inside our body, there are the a€?intrinsica€? (internal) structures and molecules of the organism, which are either a€?resonatinga€? because of their physical nature (as with stringed instruments: compare the vibration of the string alone versus string with resonator sound box), or create a certain frequency themselves. Such only a few nanometers sized processes have been discussed as possible sites of resonance induced by external EMFs, acting as a€?protein-antennasa€? (19). The research was done in a special laboratory room that was completely shielded from the natural magnetic field of the earth by tons of steel. But, if it would really be a relict, those particles would not exist in such a high quantity anymore.
Nonetheless, what these people achieved, and their courage, as well as of the publishers who rightly published their works, deserve high credits.
Although successful in some areas addressed, the effects found had not the high statistical significance required, and the methodology used was not a generally accepted one, guaranteeing medical relevance and reproducibility.
For us, the mean a€?area-of-glowa€? was the best possible means for sensitively indicate stress.
In other words, a higher GDV mean area of glow value corresponds to a higher IgA level (to be understood as an sign for lower stress or relaxation), and a lower GDV mean area of glow value can be understood as an indication for higher levels of alpha-amylase, i.e. In the specific setup for the static GDV images used in our study, the overall GDV image area values calculated are to be understood as mean values of 50 single finger GDV images in total, per test period. A number of further statistical analyses were performed, also including distribution-independent tests. Such areas have been dowsed within some churches and other buildings constructed centuries or often thousands of years ago.
Mental components are just as important: the more someone lives consciously, and even optimistically, in a state of positive thought, the less external stress factors can influence the person somatically.


Possibilities to minimize the effects of geopathy on our organism in general have already been discussed above.
Thus, for this practical reason it may be worth considering installing a device that has a balancing effect here. The results of our research are of great relevance for a€?wellness-centersa€? too: sustainable success in relaxation and stress management methods is essentially dependent upon the particular location of sleeping and of therapy beds.
The number of staff on sick leave will probably decrease in the long run, when all employees work at geopathically (and otherwise also) more balanced work places. Soon, we shall have completed those experiments testing a number of test persons sufficiently high for good-practice statistical examination. Petersburg Division of the Russian Ministry of Culture, State Editing and Publishing Unit a€?Kulturaa€™, Petersburg, pp 58a€“83 (1999). After hundreds of tests, I can say: With special ion meters (electronic instruments that measure the number of small ions in the air) you can detect increased measurement values above the area of a disturbance a€“ particularly in the range of positive air ions. My electro-geobioscopic measurements use test devices that are well tested in medicine: Aschoff, MORA, and Vega.
They may play a role in such diverse pathologic processes as periodontal disease and colon cancer. The signs and symptoms of acute pneumonia develop over hours to days, whereas the clinical presentation of chronic pneumonia often evolves over weeks to months. Other common causes in the immunocompetent patient include Moraxella catarrhalis, Mycobacterium tuberculosis, and aspiration pneumonia.
Other viral causes of respiratory tract infections include parainfluenza virus, adenovirus, human metapneumovirus, herpes zoster virus (HSV), varicella-zoster virus (VZV), and measles. Inflammatory cells drawn to infected areas of the pulmonary tree release proteolytic enzymes, altering the bronchial epithelium and ciliary clearance mechanisms and stimulating the production of excess mucus. Diminished antibody production or function can accompany hematologic malignancies such as multiple myeloma or chronic lymphocytic leukemia.
The authors suggested that such patients might be eligible for outpatient antibiotic therapy without extensive laboratory evaluation. The protected brush catheter is used to distinguish quantitatively between tracheobronchial colonizers and pneumonic pathogens. These probes have excellent sensitivity and specificity but can yield false-positive results. As a result our immune system becomes weakened, which means it has difficulty in absorbing nutrients or fighting off infections as efficiently as it should. Claims and counter claims abound regarding devises to achieve this, leaving the public in total confusion.
The wave lengths of the disturbed natural radiation can seriously affect our health, causing cancer, Chronic Fatigue Syndrome (ME) infertility and miscarriage. It may surprise you therefore, that in many European countries, Germany and Austria in particular, one ofA  the first questions the doctor may ask is about theA  location of your bed and how long have you been sleeping there. Most explanations tried concentrate on the existence of natural electromagnetic fields (EMFs) present at particular locations, a€?interferinga€? with the organisms.
Overlapping, or a a€?build upa€? of resonance effects are also part of the geopathic phenomenon. With a proportion of 12 % of the upper eartha€™s crust, quartz is the most frequent mineral after feldspar.
In the case of resonance, both sources attract each other, which can be explained and calculated by the occurrence of field changes during that process (5). When experimentally irradiated by EMFs of frequencies in between about 1-2 GHz, they displayed a changing of conformation, respectively changing in their manner of oscillation, even when only very low field strengths had been applied (19). Magnetic particles in the brain could turn out to be one of the reasons why dowsing can work. Furthermore, one can acquire a€?corona diagramsa€? in the manner of complementary medicine from the individual allocation of the a€?coronaa€? gas discharge from the different fingertips, following the principles of the energya€“meridian theory and of acupuncture. The exact test design, as well as the way how dowsers independently labeled the different zones in the laboratory test room, have been described in detail (24). The glass plate surface of the GDV camera was cleaned using alcohol frequently, and it was taken care that none of the test persons had wet hands. The corona diagrams directed into a weakening of the energies of the immune system and the pineal organ (which might be understood as an indication of possible changes of the melatonin production) (compare to: 57-60), the cardiovascular and the urinary system in many of the test persons. The a€?Wavea€? device investigated in our study could therefore, by its balancing effect, not only aid in lowering of stress, but also be understood as a tool for disease prevention. Concerning the a€?Wavea€? device especially interesting is the fact, that it substantially reduces stress in people on a€?neutral zonesa€? too, a finding which indicates that there is no real a€?neutral zonea€? existing.
In the following, we will briefly show what addressing geopathy do affect health care facilities, public places, and economy. By inference, if these results are applied to public facilities in general, the a€?Wavea€? could probably have a number of desirable effects in schools, offices, banks, supermarkets, etc.
Contrarily, at a€?highly burdeneda€? workplaces, performance will decrease, discontentment grows, and the vulnerability to diseases and the resulting rise of employees' illnesses will be greater. Ursula DEMARMELS-HACKER, for her love and support, and for abandoning many evenings and weekends of togetherness to find time for investigation and creation of this manuscript.
The key characters for classification are motility, arrangement of flagella, organic and volatile fatty acid metabolic end products and cellular fatty acid patterns.
Bacteroides, Prevotella, Porphyromonas, and Fusobacterium produce enzymes (collagenase, neuraminidase, deoxyribonuclease, deoxyribonuclease [DNase], heparinase, and proteinases) that may play a role in pathogenesis by helping the organisms to penetrate tissues and to set up infection after surgery or other trauma. Note the filaments with swollen central portions, large round bodies, and irregular staining. Examination findings are localized to a specific lung zone and can include rales, rhonchi, bronchial breath sounds, dullness, increased fremitus, and egophony. Infection with SARS-associated coronavirus is most often diagnosed by antibody testing and polymerase chain reaction (PCR) testing. A secondary infection, such as postinfluenza staphylococcal pneumonia, might prove resistant to initial therapy. From an incredible range of gadgets offered there are many tales about their ineffectiveness or of making the receiver feel much worse. These questions are routinely asked not only by several thousand doctors, but also many cancer specialist hospitals will recommend a Geopathic Surveyor or Geobiologist as they are often called to investigate your home before deciding on a course of therapy or reaching for the prescription pad. It was reckoned with over 95 a€“ percentile certainty that there is a location influence on the governing system of the circulation. Many a€?specialistsa€? presume that the origin to be in the ground a€“ below the earth surface. Furthermore, technically generated EMFs are present on every place on earth; their likely influence on our health is presently the subject of intensive worldwide research. Whittaker already in 1904 showed mathematically that the known and accepted Laplace Wave Equation of the year 1787, besides indicating transversal electro-magnetic waves, also describes longitudinal scalar waves (15).
The magnetite-particles could also be visualized and further analyzed using a high-definition transmission electron microscope. In any case, magnetite crystals in the brain could possibly be a hint to explain how (certain qualities of) geopathic zones may affect the body: Magnetite reacts more than one million times stronger to an external magnetic field than every other biological material. Using that particular aspect, we were able to indicate which organ systems of the body might be affected by geopathic stress. A third marker, saliva cortisol, although displaying its very own rhythmicity, also appears to fit into the concept that GDV could be reliably used for biophysical stress measurement (Hacker and Augner, unpublished results).
Altogether, more than 137,000 individual fingertip GDV corona images were captured, interpreted by means of computer-aided image analysis and analyzed in detail using bio-statistics. For further calculations and analyses, the GDV Meridian Analysis and the GDV Diagram software (both with version no.
The latter device had been mounted or de-mounted in another room at an upper floor, and neither the test persons nor the examiners could see if the device was present or not. The test persons were advised to keep their fingers still and relaxed during measurements and not to apply undue pressure when putting their fingers onto the glass plate at an angle of approximately 30-degrees to the instrument axis (28). If present for a prolonged time, however, eustress may soon turn to distress and thereby suppress the immune system.
We would therefore suggest using a terminology towards a a€?more geopathica€? and a€?geologically more neutrala€? zone in this context.
Johanns-Hospital, so far, more than 50 a€?Wavea€? devices have been installed to harmonize critical locations - especially in the intensive care unit and in the entire surgical ward), and at other major hospitals (e.g. Thus, especially in already existing establishments, the purposeful placement of a€?Wavea€? devices can be of great benefit.
The aggregate economic success of a company or institution can very well be in the balance; responsible (and visionary) managers should take heed of the results of our studies in their plans and act accordingly. Petersburg Division of Russian Ministry of Culture, State Editing and Publishing nit, a€?Kulturaa€™, pp 84a€“108 (1999). Antigens are not useful.PathogenesisThey usually invade as opportunistic pathogens through a break in the mucosa. The incidence of infection by these organisms can best be reduced or eliminated by avoiding conditions that decrease the redox potential of tissues and by preventing introduction of the anaerobes into compromised host tissues.Table 20-1Common Syndromes of Anaerobic Infection. In contrast, atypical pathogens such as Mycoplasma, Chlamydophilia, and viruses can manifest in a subacute fashion with fever, nonproductive cough, constitutional symptoms, and absent or diffuse findings on lung examination.
Given the large percentage of pneumonia cases for which no microbial cause is identified, it is likely that molecular tools will eventually be applied to the identification and antimicrobial susceptibility testing of almost all causative agents of pneumonia. The patient might fail to respond for reasons of poor adherence, poor drug absorption, or drug interaction. There are many products on the market that claim to cure some or all geopathic zones of its noxious energy. However, if we sleep in an area affected by geopathic stress, our body has to use all ita€™s energy just to keepA  vital organs going. The search, using both dowsing methods to locate geopathic energies and scientific instruments to detect man made electromagnetic energies willA  determine whether your illness is linked to geopathic stress electromagnetic stress or both. Frequencies in between about 0,1 Hz up to the GHz-range are being suggested in public literature. The most exciting result of those experiments was that, most of the regions of the brain appear to contain about five million biogenous a€?single-domaina€? magnetite crystals per gram wet weight on average, and the meninges (pia and dura mater) contain even more than 100 million. Recently, in the Annals of the New York Academy of Sciences, an article describes possible roles that magnetic ferrous amalgamations could play in neurological disease (21). The accordant calculations and projections were done interactively using specific software for analysis, based on the energy-emission-analysis according to Mandel (47-48), the Su-Jok-System of acupuncture (49) and clinical data of thousands of test persons from the St. In order to minimize chronobiologic influences to a sensible degree, the experiments were carried out only in forenoons, and also in that respect, phase randomization in time was an important prerequisite (24).
As already stated above, technical fields and noxae [nocent influences] of different kinds are present everywhere on earth. In the workplace and in the home: this is only part of the whole picture, because a€?ready to goa€? or rested and productive employers and employees should also be able to benefit at peace and harmony at home.
Numerous studies of the endotoxin of Gram-negative anaerobic bacilli have determined that the B fragilis endotoxin contains little or no lipid A, 2-ketodeoxyoctanate, or heptose. The endotoxin varies from strain to strain in its content of 2-ketodeoxyoctanate and sugars. Rapid progression of disease to respiratory failure can be seen in severe pneumococcal or Legionella pneumonia.
Most of these claims are quite dubious and do not stand up to the most rudimental scientific testing. As a result our immune system becomes weakened, which means it doesna€™t absorb nutrients or fight off infections effectively. If so, you will be advised how to avoid or eliminate these harmful energies from your home so you stand a better chance of responding to any treatment given. In our following attempts at explanation, we will concentrate on natural sources possibly originating from the a€?grounda€?, i.e.
As we could show, the a€?Wavea€? device in fact can help, and its exceptional promise as a preventive measure is of great interest.
Gerfried BRANDSTETTER (manager of the science department of the Salzburg federal government); Landeshauptfrau Mag.
Although biologic activity varies also, many strains do show strong biologic activity, comparable to that of Salmonella enteritidis.
Fortunately there are now a growing number of dowsers that are equipped with scientific monitoring instruments that can test such claims. To locate geopathic stress dowsers visit land, offices and homes where theyA  seekA  the location of underground streams, geological faults or the eartha€™s natural grid lines. This endotoxin exhibits little biologic activity in various test systems and little chemotactic activity; what activity there is is complement-mediated by the alternative pathway.
The endotoxin of F nucleatum also is variable in its biologic activity, but often exhibits strong activity, comparable to that of S enteritidis.Bacteriophages active against B fragilis are not uncommon.
In most clinical infections, only the genera Bacteroides, Prevotella, and Fusobacterium need be considered.
Poor biologic activity of endotoxin also has been demonstrated for the closely related species B thetaiotaomicron, B ovatus, B vulgatus, and B distasonis. However, for thousands of years people from all over the world have been finding underground water for wells and mineral deposits to mine by dowsing methods. By electron microscopy, the ultrastructure of B fragilis is similar to that of other Gram-negative bacteria. Prevotella melaninogenica endotoxin contains no heptose or 2-ketodeoxyoctanate, and it and the endotoxin of P oralis both show weak biologic activity. Remember ita€™s the energy from the water and other artefacts that they first respond to as it rises from deep beneath the ground to the surface. Within the Bacteroides group, B fragilis is the most common pathogen, followed by B thetaiotaomicron and other members of the B fragilis group.
Among the bile-sensitive Prevotella species, the ones most commonly encountered clinically are P melaninogenica, P oris, and P buccae. For the most part, the biologic and clinical significance of these plasmids is not known; however, some code for resistance to such antimicrobial agents as clindamycin, erythromycin, tetracycline, chloramphenicol, ampicillin, and cephalothin. Cells of F necrophorum often are elongated or filamentous, are curved, and possess spherical enlargements and large, free, round bodies. Plasmid-mediated antibiotic resistance has been transferred from strains of B fragilis to other strains of this species, to B thetaiotaomicron, and to Escherichia coli. Fusobacterium nucleatum is the Fusobacterium species most often found as a pathogen, but F necrophorum occasionally produces serious disease. Fusobacterium nucleatum, although not producing infections as serious as those caused by F necrophorum, is a virulent organism and is much more common clinically. Such resistance also has been transferred from B distasonis to B fragilis.Most strains of the B fragilis group can deconjugate bile acids and are equally active whether the bile acid is conjugated with glycine or with taurine.
The cells of this species are usually spindle shaped, are 5 to 10 μm long, and are often seen in pairs, end to end.
Rarely, P melaninogenica may deconjugate bile acids, but in general this species, P oralis, and F nucleatum are inhibited by bile acids and do not deconjugate them. Fusobacterium necrophorum also is active in deconjugating bile acids but is active primarily on taurine conjugates. A few strains of Gram-negative anaerobic bacilli can convert primary bile acids to secondary bile acids. Because lithocholic acid is toxic in humans and has been shown to exert tumor-promoting activity in animals, this reaction may be important.
Glucuronidase produced by anaerobic Gram-negative bacilli may be of special significance in deconjugating compounds that had previously been detoxified in the liver by combination with glucuronide.
The activity of B thetaiotaomicron, B distasonis, and other members of the B fragilis group against plant polysaccharides, chondroitin, and mucin may be a factor in colon cancer and other disorders. Dietary fiber consists primarily of plant cell wall polysaccharides that are not digested in the stomach or small bowel.Certain Bacteroides species possess distinguishing enzymes. Superoxide dismutase has been found in B fragilis, B thetaiotaomicron, B vulgatus, and B ovatus. In general, a good correlation exists between superoxide dismutase activity and oxygen tolerance. No consistent relationship has been found between catalase activity and oxygen tolerance, however. The latter organism also produces an agarase, which accounts for pitting of the agar by the colonies. A related pitting organism, Sutterella wadsworthensis, is much more pathogenic and is relatively resistant to antimicrobial agents.PathogenesisBacteroides, Prevotella, Porphyromonas, and Fusobacterium species are prevalent in the indigenous flora on all mucosal surfaces. They may have an opportunity to penetrate tissues and then to set up infection under certain circumstances such as surgical or other trauma or when tumors arise at the mucosal surface (Table 20-2). In certain cases, such as aspiration pneumonia, anaerobic bacteria from a site of normal carriage may move into another area that is normally free of organisms and infect that site.
Tissue necrosis and poor blood supply lower the oxidation-reduction potential, thus favoring the growth of anaerobes. Accordingly, vascular disease, cold, shock, trauma, surgery, foreign bodies, cancer, edema, and gas production by bacteria may significantly predispose individuals to infection with anaerobes, as may prior infection with aerobic or facultative bacteria.
The more aerotolerant anaerobes are more likely to survive after the normally protective mucosal barrier is broken and until conditions are satisfactory for their multiplication and invasion. Once anaerobes begin to multiply, they can maintain their own reduced environment by excreting end products of fermentative metabolism.
Infections involving Gram-negative anaerobic bacilli often are characterized by abscess formation and tissue destruction.Table 20-2Conditions Predisposing to Anaerobic Infection. Bacteroides, Prevotella, Porphyromonas, and Fusobacterium species produce enzymes that may play a role in pathogenesis. Prevotella melaninogenica is one of the few bacteria that produce collagenase, an enzyme of considerable importance.
Cell extracts of P melaninogenica strains with collagenolytic activity, when given with a live Fusobacterium species, produce more severe lesions in rabbits than does the organism or the extract given alone.
This enzyme alters neuraminic acid-containing glycoproteins of human plasma; Bacteroides strains isolated from clinical specimens have higher neuraminidase activity than do those isolated from stools, and strains of the B fragilis group have greater activity of this type than do strains of other Gram-negative anaerobic bacillary species.
Hyaluronidase is produced by many strains of the B fragilis group and pigmented anaerobic Gram- negative rods.
A heparinase produced by B fragilis strains may contribute to intravascular clotting and hence increase the dosage of heparin needed to treat septic thrombophlebitis in infections caused by this organism. The lipopolysaccharides of B fragilis, B vulgatus, and F mortiferum activate the Hageman factor and thereby initiate the intrinsic pathway of coagulation. Fibrinolysin is produced by many P melaninogenica group strains and by a few B fragilis group strains. Porphyromonas asaccharolytica produces proteinases that render it capable of hydrolyzing gelatin, casein, coagulated protein, plasma protein, azacol, and collagen.
Strains of Bacteroides and P gingivalis degrade complement factors and immunoglobulins G and M.
A strain of P melaninogenica produces phospholipase A.Fusobacteria necrophorum produces a leukocidin and hemolyses erythrocytes of humans, horses, rabbits, and, much less extensively, sheep and cattle.
Certain F necrophorum cells hemagglutinate the erythrocytes of humans, chickens, and pigeons.
A bovine isolate of F necrophorum demonstrates phospholipase A and lysophospholipase activity.
Fusobacterium gonidiaformans produces an appreciable inflammatory reaction when inoculated into the skin of rabbits; when injected intraperitoneally into mice, it leads to liver abscesses and occasionally to death. A specific toxin has not yet been isolated.Other factors may be involved in the continued growth and potential pathogenicity of certain anaerobes. Also, anaerobes such as P melaninogenica sometimes inhibit phagocytosis and killing of other organisms during mixed infection.
Pili (fimbriae) and lectinlike adhesins may also be important in the adherence of Bacteroides cells to epithelial surfaces.
Butyrate and succinate produced by Bacteroides show a cytotoxic effect.Host DefensesPolymorphonuclear leukocytes have oxygen-dependent and oxygen-independent microbicidal systems. Components of both systems might be important in phagocytic killing of anaerobes under conditions of varying oxygen tension. Specifically, polymorphonuclear leukocytes normally kill B fragilis under anaerobic and aerobic conditions.
Random migration of polymorphonuclear leukocytes does not differ significantly under aerobic and anaerobic conditions. Bacteroides fragilis, one organism used in the chemotaxis study described above, is more resistant to the normal bactericidal activity of serum than are other members of the B fragilis group.
Fusobacterium mortiferum is killed by serum alone or by serum plus leukocytes under aerobic and anaerobic conditions.
Under anaerobic conditions, B thetaiotaomicron and B fragilis are phagocytosed and killed intracellularly by human polymorphonuclear leukocytes only in the presence of normal human serum.
Similar results are obtained in an aerobic environment, except that B fragilis is phagocytosed and killed intracellularly to some extent in the absence of serum. There is evidence that the capsule of certain strains interferes with their phagocytosis.Immunoglobulin and components of the classic and alternative complement pathways participate in chemotaxis, bacteriolysis, and opsonophagocytic killing of various Gram-negative anaerobic bacilli. Antibody to the capsular polysaccharide of B fragilis can be induced in animals by infection with encapsulated strains or by implantation of the capsular material itself along with outer membrane components that stimulate an antibody response. Such immunization of animals confers significant protection against subsequent abscess development from B fragilis strains. Furthermore, a study of women with acute pelvic inflammatory disease demonstrated antibody to the capsular antigen of B fragilis in women whose infecting flora contained B fragilis; the antibody was quantified by precipitin analysis.
Immunodiffusion techniques have also been used on trichloracetic acid extracts from B fragilis in detecting precipitating antibodies against this organism in sera of immune rabbits. Knowledge of the composition of the indigenous flora at various sites under different circumstances permits the clinician to anticipate the likely infecting species in acute infections at different locations. Ecologic determinants include the oxygen sensitivity of various organisms, the ability of organisms to adhere (discussed in Chapter 7), and microbial interrelationships. In the human gingival crevice area, Gram-negative anaerobic rods account for 16 to 20 percent of the total cultivable flora. Prevotella melaninogenica is seldom isolated before the age of 6 years, but by the early teens this organism can be isolated from the gingival crevice area of most individuals.
Gram-negative anaerobic rods usually constitute 8 to 17 percent of the cultivable flora of human dental plaque. In the terminal ileum, approximately equal numbers of facultative aerobes and anaerobes are present, with Bacteroides being one of the major anaerobes. B thetaiotaomicron and B vulgatus are the dominant species of Bacteroides encountered, followed by B distasonis, B ovatus, and B fragilis.
In animal studies, Bacteroides protects against infection with Salmonella or Shigella.Bacteroides, Prevotella, and Fusobacterium species are common in the vaginal flora. Species recovered from the normal cervical flora of healthy women include B fragilis, B capillosus, P oralis, P bivia, P disiens, P oris, P buccae, and B ureolyticus.Studies of the normal urethral flora are relatively limited, but Fusobacterium and other Gram-negative anaerobic bacilli have been isolated. Clearly, however, the source of infection with these organisms is the indigenous flora of the body, particularly of mucosal surfaces.DiagnosisThe clinical characteristics of infection with Bacteroides, Prevotella or Fusobacterium are primarily those seen with anaerobes in general. These characteristics include foul-smelling discharge, location of infection in proximity to mucosal surfaces, tissue necrosis, gas in tissues or discharges, association of infection with cancer, infection related to the use of aminoglycosides or other agents with poor activity against anaerobes, septic thrombophlebitis, infection following human or animal bites, and certain distinctive clinical features. The clinical presentation of F necrophorum sepsis may be distinctive in that onset is characterized by sore throat and fever often accompanied by chills.
A membranous tonsillitis with foul odor to the breath may be noted, and in the absence of effective therapy, bacteremia and widespread metastatic infection occurs. Black discoloration of blood-containing exudates or red fluorescence of such exudates under ultraviolet light indicates infection with pigmented anaerobic Gram-negative bacilli.A definitive diagnosis requires demonstration or isolation of the organisms responsible for the infection. Even direct Gram stain may be helpful because of the frequently unique morphology of Gram-negative anaerobic bacilli. Fusobacterium cells may exhibit classic tapered ends and filamentous forms, with or without swollen areas and large round bodies. Direct gas-liquid chromatography of clinical specimens occasionally provides important clues to the presence of certain Gram-negative anaerobic bacilli. A large amount of butyric acid in the absence of isobutyric or isovaleric acid indicates the presence of Fusobacterium. The presence of succinic acid and only Gram-negative rods seen on Gram stain, or of both succinic and isobutyric acid in the specimen, indicates that Bacteroides is present. Both direct and indirect fluorescent antibody techniques may be useful for rapid detection of Bacteroides, Prevotella, and Fusobacterium in clinical material.
Collection of clinical specimens should avoid the mucosal flora, and transport must be anaerobic. Use of selective and differential media may facilitate isolation and identification of different Gram-negative anaerobic bacilli. Patients with acute leukemia who are to be treated intensively with antitumor chemotherapy may be managed with a diet low in bacterial count and with administration of an antimicrobial regimen designed to reduce significantly the total body flora, including anaerobes.
Some workers have advocated using antibacterial regimens that are relatively inactive against anaerobes; as a result, anaerobes persist in the bowel and provide colonization resistance against potential aerobic or facultative pathogens. There is some disagreement on this point.Anaerobic bacteremia following dental manipulation may be managed effectively by administering an antibacterial agent 1 hour before the manipulation and continuing for a limited period (12 to 24 hours) afterward. The effectiveness of prophylactic antimicrobial therapy before bowel surgery is now well established. The physician may use oral neomycin plus erythromycin, giving the agents for a limited time before surgery to prevent overgrowth of other organisms.
When infection already is established but surgery is indicated (appendectomy, cholecystectomy), antimicrobial therapy just before surgery again may be helpful. Appropriate therapy of established infections such as chronic otitis media and sinusitis may prevent subsequent spread of infection that could lead to intracranial abscess. Precautions to minimize aspiration are helpful in preventing anaerobic pulmonary infection. Care must be observed in feeding feeble or confused patients and those who have difficulty swallowing. The use of closed methods of bowel resection, when feasible, decreases the likelihood of infection with members of the bowel flora.Table 20-3 indicates the relative effectiveness of a number of drugs against Gram-negative anaerobic bacilli. Ampicillin, carbenicillin, and penicillin V are roughly comparable to penicillin G on a weight basis, but the high blood levels safely achieved with carbenicillin and similar penicillins make them effective against 80 to 95 percent of B fragilis strains. Cefoxitin, which is resistant to penicillinase and cephalosporinase, used to be active against 95 percent of B fragilis strains, but now 25 percent of strains are resistant in some centers. The third-generation cephalosporins are usually less active than cefoxitin against the B fragilis group. In addition to antimicrobial therapy, surgery is important in treating anaerobic infection. This includes drainage of abscesses, excision of necrotic tissue, relief of obstruction, and ligation or resection of infected veins. Lung abscess, which responds well to medical therapy, is the primary exception to the rule that abscesses require surgical drainage.Hyperbaric oxygen therapy is not useful in Gram-negative anaerobic rod infections.
General supportive measures are, of course, important in managing any type of serious infection. Anticoagulation may be useful in patients with septic thrombophlebitis, along with appropriate antimicrobial therapy.As noted above, the B fragilis group is among the most resistant of all anaerobes to antimicrobial agents.
In part, this is related to β-lactamase production by B fragilis and related strains, but other mechanisms of resistance exist as well. Sutterella wadsworthensis is often resistant to metronidazole and sometimes to penicillins (including piperacillin).
Bilophila is also often resistant to penicillins by virtue of β-lactamase production. Plasmid-mediated transferable resistance to several antimicrobial agents has been demonstrated with B fragilis and related Bacteroides species.
Numerous other anaerobic Gram-negative bacillary species also produce β-lactamases.
Chloramphenicol acetyltransferase and nitroreductase have been demonstrated in Bacteroides but are not generally clinically significant.



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