We studied the causes of community-acquired pneumonia (CAP) in 184 patients. Microbiologic evaluation included sputum examination, blood culture, assessment of acute and convalescent antibody titers for Legionella pneumophila, Mycoplasma pneumoniae, Chlamydia pneumoniae, Coxiella psitacci, Coxiella burnetii and respiratory viruses, polymerase chain reaction (PCR) assays for M. pneumoniae and C. pneumoniae in throat swab, and PCR assay based on the amplification of pneumolysin gene fragment in sera. The causative pathogen was identified in 78 patients (Streptococcus pneumoniae, 44; M. pneumoniae, 26; C. pneumoniae, 1; others, 7). S. pneumoniae was detected in serum by the PCR assay in 41 patients, five of whom also had a positive blood culture. PCR assay was negative in two patients with positive blood culture for S. pneumoniae. C. pneumoniae was detected by PCR in nine patients, but only one showed seroconversion. M. pneumoniae was detected by PCR in only three patients (two without seroconversion). The diagnosis of pneumonia caused by S. pneumoniae was five times greater using PCR in serum than with blood culture. Detection of C. pneumoniae by PCR without fulfilling criteria for acute infection may be considered a prior infection. The PCR assay for the diagnosis of M. pneumoniae has a lower sensitivity than serologic methods.

Length of stay (LOS) in hospital for community-acquired pneumonia depends on the characteristics of the patient and hospital. The present study sought to identify these variables within the first 24 h of hospitalisation.Patients hospitalised for pneumonia in four hospitals (one teaching and three general hospitals) had their data analysed by univariate and multivariate statististics. The variables entered were LOS, demographical characteristics, referral source, comorbidity, initial severity of illness, laboratory analyses, initial radiograph findings and antibiotic treatment regimens.The study sample included 425 patients. The overall mortality was 8.2% and the median LOS was 9 days. Using LOS as a dependent variable, three multivariate linear regression analyses were performed with: 1) the whole cohort; 2) the low-risk classes (categories I and II of Fine); and 3) the high-risk classes (categories III, IV and V of Fine). The mathematical model identified hypoxemia, low diastolic pressure, pleural effusion, multi-lobe involvement and hypoalbuminaemia as associated with longer stays in risk classes III-V, while in the low-risk patients (I-II) only hypoxemia and pleural effusion appeared in the equation. Following adjustment for these clinical variables, the LOS remained lower in some hospitals.Several independent clinical factors increased the pneumonia-associated length of stay with significant differences between hospitals. Hypoxemia and pleural effusions were the predictive variables of length of stay in low-risk patients and, additionally, diastolic blood pressure, multi-lobe involvement and hypoalbuminaemia were significant in the higher-risk classes III-V. Eur Respir J 2003; 22: 643-648. Community-acquired pneumonia (CAP) is the cause of hospitalisation for 3-5 per 1000 adults per year and with a mortality rate of 5-15%. Pneumonia is the infectious disease with the highest health costs [1][2][3][4] and, since approximately one-third of all patients with CAP are treated in hospital, the resulting costs constitute a significant part of the overall direct costs of infectious diseases [5][6][7]. The most important component of these costs is the length of stay (LOS) in hospital and estimates indicate these costs to be higher than those of the diagnostic tests involved and the subsequent antimicrobial treatments administered [6].There is considerable variability in LOS between hospitals. Reported findings are discordant and depend on the types of hospital in which the different studies had been conducted [8][9][10][11]. The differences might reflect variations in clinical practice preferences, hospital characteristics and patient characteristics and attitudes. Over recent years the LOS appears to have decreased from 9 to 6 days [12, 13] as a result of several strategies and practical guidelines that have been proposed in order to safely reduce the number of hospitalisation days [14].The LOS is influenced by several clinical factors, such as the Pneumonia Severity Index (PSI) [15] associated comorbidit...

The aim of this study was to evaluate the diagnostic value of a new tumour marker, cytokeratin fragment 19 (CYFRA 21-1), in bronchoalveolar lavage fluid (BALF) for the diagnosis of lung cancer. The cross-sectional study included 36 patients with lung cancer, 19 with benign lung diseases and 13 control subjects. In the group with cancer, BAL was performed in the cancer-involved lung and in the opposite lung. Results in BALF were expressed both as absolute concentrations (ng ml-1) and referred to total protein (TP) (ng mg-1 TP), and results in plasma were expressed in ng ml-1. In BALF, there was no significant different between cancer and control groups. Using the 95th percentile of levels obtained in benign lung disease in BALF (specificity 95%) as the cut-off point, the sensitivity of CYFRA 21-1 was 13%. Positive and negative predictive values (PPV and NPV) at different pretest probabilities, and positive and negative gains were obtained applying a Bayesian analysis. Results showed low positive gains for PPV (maximal increase of 22%) and almost none for NPV (negative gains < 5%). In plasma, CYFRA 21-1 provided a sensitivity of 65%. The combination of BALF and plasma tumour marker levels showed a sensitivity of 69%. Therefore, measurement of CYFRA 21-1 in BALF has poor diagnostic value in lung cancer.

The aim of this study was to evaluate the diagnostic value of three tumour markers, squamous cell carcinoma (SCC) antigen, carcinoembryonic antigen (CEA) and CYFRA 21.1, in lung cancer using a Bayesian analysis to obtain the predictive values for different pretest probabilities or prevalences. A cross-sectional study included 94 patients with lung cancer, 40 with benign lung disease, and 40 healthy controls. SCC antigen and CEA were measured in blood samples by microparticle enzyme immunoassay (MEIA), and CYFRA by enzyme-linked immunosorbent assay (ELISA). The results of tumour marker determinations were expressed as percentiles, and showed significantly higher levels in the cancer group than in the two control groups. Taking the 95th percentile of benign lung diseases as the cut-off point (specificity 95%), the following sensitivities were found: SCC 41%, CEA 31% and CYFRA 79%. After a Bayesian analysis, the best results for the three tumour markers were found in prevalences of 30-40%. The highest incremental gain was obtained by CYFRA (at prevalence of 36%, positive and negative predictive value approximately 90%). The three tumour markers were included in a stepwise regression analysis to predict lung cancer, and CYFRA was the only selected variable. We conclude that CYFRA 21.1 may be a useful marker in lung cancer when there is an intermediate pretest probability of disease.

A rare case of pulmonary nocardiosis was presented in a nonimmunocompromised patient who had chronic airway obstruction and bronchiectasis without corticoid treatment. The microbial diagnosis was established after isolating Nocardia in bronchial aspirate and sputum samples. An in vitro study showed sensitivity only to imipenem, netilmicine, amikacin and ofloxacin. The evolution was chronic, with multiple clinical recurrences in spite of prolonged antibiotic treatment. Finally, the eradication of Nocardia was achieved with the combination of imipenem and amikacin.