New Discoveries Lead to More Effective Management of Pneumonia, Meningitis, and Endocarditis

Researchers at IDWeek 2012 presented new information and guidance on the diagnosis and management of three of the most deadly infectious diseases: pneumonia, meningitis, and endocarditis.

The big beasts of infectious diseases‑‑pneumonia, bacterial meningitis, and endocarditis‑‑kill a lot of people but don’t stop medical professionals from attempting to slay them in their tracks. Challenges and triumphs in the battle against these and other potentially deadly infectious diseases took center stage Saturday at IDWeek, an infectious disease conference held in San Diego that brought together researchers, doctors, public health experts, and other infectious disease professionals. IDWeek 2012 is the first joint annual meeting of the Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), HIV Medicine Association (HIVMA), and Pediatric Infectious Diseases Society (PIDS).

The World Health Organization estimates that infectious diseases kill nearly 59 million people a year, said South African Professor Charles Feldman, MD, of Charlotte Maxeke Johannesburg Academic Hospital. His presentation focused on pneumonia, one of the top killers.

“The first question is, ‘How big is this beast?’ The answer is, ‘It appears to be the biggest beast of all,’” said Feldman. Pneumonia reaches its deadly grip across the world in more places than any other disease discussed at the conference, said Feldman. “This is truly a global disease,” he said.

Health care-associated pneumonia is getting a lot of attention particularly because “it clearly is a problem in the way it’s managed and overtreated,” Feldman said. These patients are often sicker and have diseases that require them to have regular contact with hospitals and the people who work there.

Vincent Quagliarello, MD, of Yale University’s School of Medicine, highlighted advances for the treatment of meningitis, including conjugated vaccines that have had a significant impact on the so-called meningitis belt in sub-Saharan Africa where billions of people are at risk of repeated outbreaks of group A meningococcus.

They undergo epidemics in cycles every 5 to 12 years, explained Quagliarello, largely during the dry season when the desert wind “literally blows meningococcal across the continent,” infecting people in 25 countries.

A huge outbreak in the late ‘90s spawned a Bill Gates-funded project that eventually developed an affordable vaccine that was introduced to the population in 2010, said Quagliarello.

Adolf W. Karchmer, MD, a professor of Medicine at Harvard Medical School, joked that present-day endocarditis, his discussion topic, seems less beastly compared to other heavy hitters in the infectious disease line up. Not unlike meningitis, the mortality rate associated with endocarditis in the early part of last century made it quite beastly, but fast forward to relatively recent times and advances in diagnosis and treatment have dropped the mortality rate down to about 18%, he said.

Karchmer reviewed several studies related to surgery intervention and noted that mortality rates can depend on “when you look at the data.”

“If you look at data at the time of discharge or maybe at the end of two weeks and you’re comparing surgical intervention to medical therapy, mortality rate is increased because you’re adding surgical mortality to disease mortality,” Karchmer said. “When you look at those patients who survive a bit longer and you take them all the way out to five years, their survival rate is significantly enhanced by surgical intervention.”