Download PDF
Semin Respir Crit Care Med 2016; 37(06): 868-875
DOI: 10.1055/s-0036-1592076
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Community-Acquired Pneumonia in Latin America

Hernán A. Iannella
1   Division of Pulmonary Medicine, Hospital de Clínicas “José de San Martín”, Universidad de Buenos Aires, Argentina
,
Carlos M. Luna
1   Division of Pulmonary Medicine, Hospital de Clínicas “José de San Martín”, Universidad de Buenos Aires, Argentina
› Author Affiliations
Further Information

Publication History

Publication Date:
13 December 2016 (online)

    Permissions and Reprints

Abstract

Community-acquired pneumonia (CAP) is associated with significant morbidity and mortality in Latin America and the Caribbean (LAC) region. Poverty, socioeconomic factors, and malnutrition influence the incidence and outcome of CAP in LAC. In LAC, Streptococcus pneumoniae is the most frequent microorganism responsible for CAP, (incidence: 24–78%); the incidence of atypical microorganisms is similar to other regions of the world. Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is a growing problem in the LAC region, with the Caribbean being the second most affected area worldwide after Sub-Saharan Africa. Pneumococcal pneumonia remains the most common cause of CAP in HIV-infected patients, but Pneumocystis jirovecii and tuberculosis (TB) are also common in this population. The heterogeneity of the health care systems and social inequity between different countries in LAC, and even between different settings inside the same country, is a difficult issue. TB, including multidrug-resistant TB, is several times more common in South American and Central American countries compared with North America. Furthermore, hantaviruses circulating in the Americas (new world hantaviruses) generate a severe respiratory disease called hantavirus pulmonary syndrome, with an associated mortality as high as 50%. More than 30 hantaviruses have been reported in the Western Hemisphere, with more frequent cases registered in the southern cone (Argentina, Chile, Uruguay, Paraguay, Bolivia, and Brazil). Respiratory viruses (particularly influenza) remain an important cause of morbidity and mortality, particularly in the elderly. Low rates of vaccination (against influenza as well as pneumococcus) may heighten the risk of these infections in low- and middle-income countries.

Keywords

Latin America - community-acquired pneumonia - epidemiology - hantavirus
 

  • References

  • 1 World Population Prospects. 2015 Revision. United Nations Department of Economic and Social Affairs. Population Division. Available at http://esa.un.org/unpd/wpp/publications/files/key_findings_wpp_2015.pdf. Accessed May 13, 2016
    PubMedGoogle Scholar
  • 2 The World Bank. World Development Indicators. Available at http://data.worldbank.org/data-catalog/world-development-indicators . Accessed May 2, 2016
    PubMedGoogle Scholar
  • 3 World Health Organization. 10 leading causes of death in the world, 2000 and 2012. Updated May 2014. Available at http://www.who.int/mediacentre/factsheets/fs310/en/ . Accessed April 28, 2016
    PubMedGoogle Scholar
  • 4 Isturiz RE, Luna CM, Ramirez J. Clinical and economic burden of pneumonia among adults in Latin America. Int J Infect Dis 2010; 14 (10) e852-e856
    CrossrefPubMedGoogle Scholar
  • 5 Valenzuela MT, O'Loughlin R, De La Hoz F , et al. The burden of pneumococcal disease among Latin American and Caribbean children: review of the evidence. Rev Panam Salud Publica 2009; 25 (3) 270-279
    PubMedGoogle Scholar
  • 6 Economic Commission for Latin America and the Caribbean (ECLAC), Latin American and Caribbean Center of Demography (CELADE) - Population Division. Long term population estimates and projections 1950-2100. 2013 Revision. Available at http://www.cepal.org/en/long-term-population-estimates-and-projections-1950-2100 . Accessed April 4, 2016
    PubMedGoogle Scholar
  • 7 Barreto SM, Miranda JJ, Figueroa JP , et al. Epidemiology in Latin America and the Caribbean: current situation and challenges. Int J Epidemiol 2012; 41 (2) 557-571
    CrossrefPubMedGoogle Scholar
  • 8 United Nations Development Programme. Human Development Report 2015. Available at http://hdr.undp.org/sites/default/files/2015_human_development_report.pdf. Accessed May 21, 2016
    PubMedGoogle Scholar
  • 9 The World Bank. World Bank Country and Lending Groups. Gross national income (GNI) per capita calculated using the World Bank Atlas method. Available at http://data.worldbank.org/about/country-and-lending-groups . Accessed May 12, 2016
    PubMedGoogle Scholar
  • 10 Biggs B, King L, Basu S, Stuckler D. Is wealthier always healthier? The impact of national income level, inequality, and poverty on public health in Latin America. Soc Sci Med 2010; 71 (2) 266-273
    CrossrefPubMedGoogle Scholar
  • 11 Thörn LK, Minamisava R, Nouer SS, Ribeiro LH, Andrade AL. Pneumonia and poverty: a prospective population-based study among children in Brazil. BMC Infect Dis 2011; 11: 180
    CrossrefPubMedGoogle Scholar
  • 12 Feldman C, Brink A, Bateman GA, Maartens G, Bateman ED ; Working Group of the South African Thoracic Society. Management of community-acquired pneumonia in adults. S Afr Med J 2007; 97 (12 Pt 2): 1296-1306
    PubMedGoogle Scholar
  • 13 Pan American Health Organization (PAHO). Health Situation in the Americas: Basic Indicators 2014. Available at http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=27299&Itemid=270 . Accessed April 25, 2016
    PubMedGoogle Scholar
  • 14 Benito N, Moreno A, Miro JM, Torres A. Pulmonary infections in HIV-infected patients: an update in the 21st century. Eur Respir J 2012; 39 (3) 730-745
    CrossrefPubMedGoogle Scholar
  • 15 Cillóniz C, Polverino E, Ewig S , et al. Impact of age and comorbidity on cause and outcome in community-acquired pneumonia. Chest 2013; 144 (3) 999-1007
    CrossrefPubMedGoogle Scholar
  • 16 Luna CM, Palma I, Niederman MS , et al. The impact of age and comorbidities on the mortality of patients of different age groups admitted with CAP. Ann Am Thor Soc 2016; (e-pub ahead of print)
    PubMedGoogle Scholar
  • 17 De Maio FG. Understanding chronic non-communicable diseases in Latin America: towards an equity-based research agenda. Global Health 2011; 7: 36-43
    CrossrefPubMedGoogle Scholar
  • 18 Müller F, Wehbe L. Smoking and smoking cessation in Latin America: a review of the current situation and available treatments. Int J Chron Obstruct Pulmon Dis 2008; 3 (2) 285-293
    CrossrefPubMedGoogle Scholar
  • 19 Vergis EN, Yu VL. New directions for future studies of community-acquired pneumonia: optimizing impact on patient care. Eur J Clin Microbiol Infect Dis 1999; 18 (12) 847-851
    CrossrefPubMedGoogle Scholar
  • 20 Luna CM, Famiglietti A, Absi R , et al. Community-acquired pneumonia: etiology, epidemiology, and outcome at a teaching hospital in Argentina. Chest 2000; 118 (5) 1344-1354
    CrossrefPubMedGoogle Scholar
  • 21 Jardim JR, Rico G, de la Roza C , et al; Grupo de Estudio Latinoamericano CAP. A comparison of moxifloxacin and amoxicillin in the treatment of community-acquired pneumonia in Latin America: results of a multicenter clinical trial in Spanish]. Arch Bronconeumol 2003; 39 (9) 387-393
    PubMedGoogle Scholar
  • 22 Díaz A, Barria P, Niederman M , et al. Etiology of community-acquired pneumonia in hospitalized patients in chile: the increasing prevalence of respiratory viruses among classic pathogens. Chest 2007; 131 (3) 779-787
    CrossrefPubMedGoogle Scholar
  • 23 Contreras CL, Verani JR, Lopez MR , et al. Incidence of hospitalized pneumococcal pneumonia among adults in Guatemala, 2008-2012. PLoS ONE 2015; 10 (10) e0140939
    CrossrefPubMedGoogle Scholar
  • 24 Stamboulian D, Vazquez H, Confalonieri V , et al. Multicenter retrospective study on Streptococcus pneumoniae serotypes isolated from adult patients with invasive pneumococcal disease in Latin America. (Abstract). ID week 2014, Philadelphia, PA. Available at https://idsa.confex.com/idsa/2014/webprogram/Paper47038.html . Accessed July 25, 2016
    PubMedGoogle Scholar
  • 25 Arnold FW, Summersgill JT, Lajoie AS , et al; Community-Acquired Pneumonia Organization (CAPO) Investigators. A worldwide perspective of atypical pathogens in community-acquired pneumonia. Am J Respir Crit Care Med 2007; 175 (10) 1086-1093
    CrossrefPubMedGoogle Scholar
  • 26 Wayne PA. Performance standards for antimicrobial susceptibility testing: 18th informational supplement. Clinical and Laboratory Standards Institute. CLSI document M100-S18. 2008. (No longer available online)
    PubMedGoogle Scholar
  • 27 Weinstein MP, Klugman KP, Jones RN. Rationale for revised penicillin susceptibility breakpoints versus Streptococcus pneumoniae: coping with antimicrobial susceptibility in an era of resistance. Clin Infect Dis 2009; 48 (11) 1596-1600
    CrossrefPubMedGoogle Scholar
  • 28 Felmingham D, Reinert RR, Hirakata Y, Rodloff A. Increasing prevalence of antimicrobial resistance among isolates of Streptococcus pneumoniae from the PROTEKT surveillance study, and compatative in vitro activity of the ketolide, telithromycin. J Antimicrob Chemother 2002; 50 (Suppl S1): 25-37
    PubMedGoogle Scholar
  • 29 Klugman KP, Lonks JR. Hidden epidemic of macrolide-resistant pneumococci. Emerg Infect Dis 2005; 11 (6) 802-807
    CrossrefPubMedGoogle Scholar
  • 30 Song JH, Jung SI, Ko KS , et al. High prevalence of antimicrobial resistance among clinical Streptococcus pneumoniae isolates in Asia (an ANSORP study). Antimicrob Agents Chemother 2004; 48 (6) 2101-2107
    CrossrefPubMedGoogle Scholar
  • 31 Bonofiglio L, Ojeda MI, de Mier C , et al. Phenotypic and genotypic characterization of macrolide resistant Streptococcus pneumoniae recovered from adult patients with community-acquired pneumonia in an Argentinian teaching hospital. Int J Antimicrob Agents 2005; 25 (3) 260-263
    CrossrefPubMedGoogle Scholar
  • 32 Reijtman V, Gagetti P, Faccone D , et al. Macrolide resistance in Streptococcus pneumoniae isolated from Argentinian pediatric patients suffering from acute otitis media. Rev Argent Microbiol 2013; 45 (4) 262-266
    PubMedGoogle Scholar
  • 33 Arnold FW, Wiemken TL, Peyrani P, Ramirez JA, Brock GN ; CAPO authors. Mortality differences among hospitalized patients with community-acquired pneumonia in three world regions: results from the Community-Acquired Pneumonia Organization (CAPO) International Cohort Study. Respir Med 2013; 107 (7) 1101-1111
    CrossrefPubMedGoogle Scholar
  • 34 Niederman MS, Luna CM. Community-acquired pneumonia guidelines: a global perspective. Semin Respir Crit Care Med 2012; 33 (3) 298-310
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Luna CM, Calmaggi A, Caberloto O , et al. Neumonía acquired in the community. Practical guide elaborated by a committee intersocieties. [in Spanish]. Medicina (B Aires) 2003; 63: 319-343
    PubMedGoogle Scholar
  • 36 Lopardo G, Basombrío A, Clara L , et al. Guidelines for management of community-acquired pneumonia in adults [in Spanish]. Medicina (B Aires) 2015; 75 (4) 245-257
    PubMedGoogle Scholar
  • 37 Grupo de trabajo de la Asociación Latinoamericana del Tórax (ALAT). Update to the Latin American Thoracic Association (ALAT) recommendations on community acquired pneumonia. Arch Bronconeumol 2004; 40 (8) 364-374
    PubMedGoogle Scholar
  • 38 Corrêa Rde A, Lundgren FL, Pereira-Silva JL , et al; Comissão de Infecções Respiratórias e Micoses - Sociedade Brasileira de Pneumologia e Tisiologia. Brazilian guidelines for community-acquired pneumonia in immunocompetent adults - 2009. J Bras Pneumol 2009; 35 (6) 574-601
    CrossrefPubMedGoogle Scholar
  • 39 Bantar C, Curcio D, Jasovich A , et al. Updated acute community-acquired pneumonia in adults: guidelines for initial antimicrobial therapy based on local evidence from the South American Working Group (ConsenSur II) [in Spanish]. Rev Chilena Infectol 2010; 27 (Suppl. 01) S9-S38
    PubMedGoogle Scholar
  • 40 Zar HJ, Madhi SA, Aston SJ, Gordon SB. Pneumonia in low and middle income countries: progress and challenges. Thorax 2013; 68 (11) 1052-1056
    PubMedGoogle Scholar
  • 41 Freedman DO, Weld LH, Kozarsky PE , et al; GeoSentinel Surveillance Network. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med 2006; 354 (2) 119-130
    CrossrefPubMedGoogle Scholar
  • 42 Cabello H, Labarca G, Fernández-Bussy S , et al. Treatment failure in community-acquired pneumonia: coccidioidomycosis in a traveler patient [in Spanish]. Rev Chilena Infectol 2013; 30 (6) 669-672
    CrossrefPubMedGoogle Scholar
  • 43 Saubolle MA. Fungal pneumonias. Semin Respir Infect 2000; 15 (2) 162-177
    CrossrefPubMedGoogle Scholar
  • 44 Cheng JW, Hayden MK, Singh K , et al. Burkholderia pseudomallei infection in US traveler returning from Mexico, 2014. Emerg Infect Dis 2015; 21 (10) 1884-1885
    CrossrefPubMedGoogle Scholar
  • 45 Bellomo CM, Pires-Marczeski FC, Padula PJ. Viral load of patients with hantavirus pulmonary syndrome in Argentina. J Med Virol 2015; 87 (11) 1823-1830
    CrossrefPubMedGoogle Scholar
  • 46 Täger Frey M, Vial PC, Castillo CH, Godoy PM, Hjelle B, Ferrés MG. Hantavirus prevalence in the IX Region of Chile. Emerg Infect Dis 2003; 9 (7) 827-832
    CrossrefPubMedGoogle Scholar
  • 47 Arancibia F, Cortes CP, Valdés M , et al. Importance of Legionella pneumophila in the etiology of severe community-acquired pneumonia in Santiago, Chile. Chest 2014; 145 (2) 290-296
    CrossrefPubMedGoogle Scholar
  • 48 Luna CM, Brea Folco J, Aruj P , et al. Pneumonia due to Legionella pneumophila. Experience gathered in a University Hospital in Buenos Aires [in Spanish]. Medicina (B Aires) 2004; 64 (2) 97-102
    PubMedGoogle Scholar
  • 49 Cicuttin GL, Degiuseppe JI, Mamianetti A , et al. Serological evidence of Rickettsia and Coxiella burnetii in humans of Buenos Aires, Argentina. Comp Immunol Microbiol Infect Dis 2015; 43: 57-60
    CrossrefPubMedGoogle Scholar
  • 50 World Health Organization. Summary table of SARS cases by country, 1 November 2002 - 7 August 2003. Available at http://www.who.int/csr/sars/country/2003_08_15/en/ . Accessed July 13th., 2016
    PubMedGoogle Scholar
  • 51 World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV). Summary of Current Situation, Literature Update and Risk Assessment 2015. Available at http://apps.who.int/iris/bitstream/10665/179184/2/WHO_MERS_RA_15.1_eng.pdf . Accessed July 13th., 2016
    PubMedGoogle Scholar
  • 52 Sreeramareddy CT, Panduru KV, Menten J, Van den Ende J. Time delays in diagnosis of pulmonary tuberculosis: a systematic review of literature. BMC Infect Dis 2009; 9: 91
    CrossrefPubMedGoogle Scholar
  • 53 Mandell LA, Wunderink RG, Anzueto A , et al; Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44 (2) (Suppl. 02) S27-S72
    CrossrefPubMedGoogle Scholar
  • 54 World Health Organization. Global Tuberculosis Report 2015. Available at http://www.who.int/tb/publications/global_report/en/ . Accessed May 14, 2016
    PubMedGoogle Scholar
  • 55 Pan American Health Organization (PAHO). Tuberculosis in the Americas: Regional Report 2014. Epidemiology, Control and Financing. 2014. Available at http://apps.who.int/iris/bitstream/10665/191102/1/9789241565059_eng.pdf?ua=1 . Accessed May 10, 2016
    PubMedGoogle Scholar
  • 56 Montoya-Ruiz C, Diaz FJ, Rodas JD. Recent evidence of hantavirus circulation in the American tropic. Viruses 2014; 6 (3) 1274-1293
    CrossrefPubMedGoogle Scholar
  • 57 Pini N. Hantavirus pulmonary syndrome in Latin America. Curr Opin Infect Dis 2004; 17 (5) 427-431
    CrossrefPubMedGoogle Scholar
  • 58 Vincent MJ, Quiroz E, Gracia F , et al. Hantavirus pulmonary syndrome in Panama: identification of novel hantaviruses and their likely reservoirs. Virology 2000; 277 (1) 14-19
    CrossrefPubMedGoogle Scholar
  • 59 Casapía M, Mamani E, García MP , et al. Hantavirus pulmonary syndrome (Rio Mamore virus) in the Peruvian Amazon region [in Spanish]. Rev Peru Med Exp Salud Publica 2012; 29 (3) 390-395
    CrossrefPubMedGoogle Scholar
  • 60 Rivas YJ, Moros Z, Morón D , et al. The seroprevalences of anti-hantavirus IgG antibodies among selected Venezuelan populations. Ann Trop Med Parasitol 2003; 97 (1) 61-67
    CrossrefPubMedGoogle Scholar
  • 61 Matheus S, Meynard JB, Rollin P, Maubert B, Morvan J. New World hantavirus in humans, French Guiana. Emerg Infect Dis 2006; 12 (8) 1294-1295
    CrossrefPubMedGoogle Scholar
  • 62 Mutsch M, Tavernini M, Marx A , et al. Influenza virus infection in travelers to tropical and subtropical countries. Clin Infect Dis 2005; 40 (9) 1282-1287
    CrossrefPubMedGoogle Scholar
  • 63 Turner R. Travel & Tourism, Economic Impact 2015, Caribbean (Report). 2015. Available at https://www.wttc.org/-/media/files/reports/economic%20impact%20research/regional%202015/caribbean2015.pdf . Accessed on August 15, 2016
    PubMedGoogle Scholar
  • 64 Fiore AE, Shay DK, Haber P , et al; Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention (CDC). Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2007; 56 (RR-6): 1-54
    PubMedGoogle Scholar
  • 65 Strikas RA, Kozarsky PE, Reed C, Kapella BK, Freedman DO. Should health-care providers in the United States have access to influenza vaccines formulated for the southern hemisphere?. J Travel Med 2008; 15 (6) 442-446
    CrossrefPubMedGoogle Scholar
  • 66 de Oliveira LH, Trumbo SP, Matus CR, Sanwogou NJ, Toscano CM. Pneumococcal conjugate vaccine introduction in Latin America and the Caribbean: progress and lessons learned. Expert Rev Vaccines 2016; 30: 1-10
    PubMedGoogle Scholar
  • 67 Kyaw MH, Lynfield R, Schaffner W , et al; Active Bacterial Core Surveillance of the Emerging Infections Program Network. Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae . N Engl J Med 2006; 354 (14) 1455-1463
    CrossrefPubMedGoogle Scholar
  • 68 Contreras CL, Verani JR, Lopez MR , et al. Incidence of hospitalized pneumococcal pneumonia among adults in Guatemala, 2008-2012. PLoS ONE 2015; 10 (10) e0140939
    CrossrefPubMedGoogle Scholar
  • 69 Saldías PF, Pérez CC. National consensus for management of community acquired pneumonia in adults. [Article in Spanish] Rev Chilena Infectol 2005; 22 (Suppl. 01) S7-S10
    PubMedGoogle Scholar