The influence of infecting serotype group on outcome in bacteraemic pneumococcal pneumonia remains unclear.We performed a prospective, 10-yr observational study in an 800-bed teaching hospital. 299 adults diagnosed with pneumonia whose blood cultures showed growth of Streptococcus pneumoniae were included in the study. High invasive disease potential (H) serotypes included serotypes 1, 5 and 7F, which served as a reference category, were compared with low invasive disease potential (L) serotypes (3, 6A, 6B, 8, 19F, and 23F) and other (O) serotypes (non-H, non-L). The influence on outcome was determined for each group of serotypes after adjusting for underlying conditions and severity of illness at admission.Overall, 30-day mortality was 11%. H serotypes (n593) infected primarily younger people and presented a higher risk of complicated parapneumonic effusion or empyema (17.2 versus 5.1%; p50.01), with lower mortality (3.2%). The isolation of L serotypes (n578) was an independent risk factor for 30-day mortality (OR 7.02, 95% CI 1.72-28.61), as were Charlson score (OR 1.30, 95% CI 1.08-1.58), alcohol abuse (OR 3.99, 95% CI 1.39-11.39) and severity of illness measured by American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) criteria (OR 4.80, 95% CI 1.89-12.13).A vaccination strategy including serotypes 3, 6A, 6B, 8, 19F and 23F may improve survival in adults.

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Many drugs may cause toxic injury to the lungs and the pleura. Cabergoline is an ergoline derivative which has been used in Spain for seven years to control symptoms of Parkinson’s disease. We report a patient with dyspnea, bilateral pleural effusion and distal swelling. After a series of complementary tests (blood analysis, chest CT, echocardiogram, pleural tap, pleural biopsy), etiological screening ruled out infection, malignancy or inflammation. Given the patient’s history of three years’ treatment with cabergoline, the drug was considered a possible cause and was progressively withdrawn. The patient’s clinical condition improved and radiological images were disease-free. Using Karch and Lasagna’s classical criteria, we defined a relationship of “probable causality” between the drug and the adverse effects reported.