Aetiology and Clinical Presentation of Mild Community-Acquired Bacterial Pneumonia

Abstract

A prospective study was initiated to analyse the bacterial aetiology and clinical picture of mild community-acquired pneumonia in Slovenia using the previously described Pneumonia Severity Index. Radiographically confirmed cases of pneumonia in patients treated with oral antibiotics in seven study centres were included. An aetiological diagnosis was attempted using culture of blood and sputum, urinary antigen testing for Streptococcus pneumoniae and Legionella pneumophila, and antibody testing for Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila in paired serum samples. One hundred thirteen patients were evaluable for clinical presentation and 109 for aetiological diagnosis. At least one pathogen was detected in 62.4% patients. The most common causative agents were Mycoplasma pneumoniae in 24.8%, Chlamydia pneumoniae in 21.1%, and Streptococcus pneumoniae in 13.8% of patients. Dual infection was detected in 8.3% of patients. Most patients suffered from cough, fatigue, and fever. Patients with atypical aetiology of pneumonia differed from those with typical bacterial pneumonia or pneumonia of unknown aetiology in age, presence of dyspnea, and bronchial breathing on lung auscultation. Patients with pneumococcal, chlamydial, and mycoplasmal infections differed in age, risk class, presence of dyspnea, bronchial breathing, and proteinuria. There was an overlap of other clinical symptoms, underlying conditions, and laboratory and radiographic findings among the groups of patients classified by aetiology. Since patients with mild community-acquired pneumonia exhibit similar clinical characteristics and, moreover, since a substantial proportion of cases are attributable to atypical bacteria, broad-spectrum antibiotic treatment seems to be recommended.

Prevalence, genotyping and macrolide resistance of Mycoplasma pneumoniae among isolates of patients with respiratory tract infections, Central Slovenia, 2006 to 2014

“…In the only two published serology-based studies available from Slovenia, one from April 1996 to March 1997 [29] and the other from November 1999 to April 2001 [30], M. pneumoniae was frequently found as the causative agent of community-acquired pneumonia in hospitalised patients (5.7% [29] and 24.8% [30]). Based on these reports and the observation of an increased number of M. pneumoniae cases from routine laboratory testing all over Slovenia in 2010 and 2014 (data not shown), we decided to analyse the occurrence of M. pneumoniae infections in in-and out-patients with RTIs.…”

Multimarker Prognostication for Hospitalized Patients with Community-acquired Pneumonia

“…Although these tools are more objective measures than dyspnea, the latter symptom is easily assessed. In previous studies, dyspnea has been observed more frequently in pneumococcal pneumonia than in pneumonia due to atypical pathogens (17), in CAP caused by Gram-negative bacilli versus other types of pathogens (18), and in CAP with asthma versus CAP without asthma (19). These earlier findings suggested the potential role of dyspnea as a predictor of mortality.…”

Ambulant erworbene Legionellenpneumonie

“…Legionellen sind für etwa 4% der ambulant erworbenen Pneumonien in Deutschland verantwortlich [2]. Höhere Inzidenzzahlen -allerdings basierend auf kleinen Fallzahlen -bis hin zu 25% wurden für Europa aus Spanien und Kroatien berichtet [3,4].Europaweit werden die meisten Infektionen als sporadische Einzelfälle erfasst [5]. Ausbrüche, wie unlängst in Ulm, sind zwar spektakulär [6], stellen jedoch insgesamt nur einen geringen Teil der Erkrankungen.…”

“…Legionellen sind für etwa 4% der ambulant erworbenen Pneumonien in Deutschland verantwortlich [2]. Höhere Inzidenzzahlen -allerdings basierend auf kleinen Fallzahlen -bis hin zu 25% wurden für Europa aus Spanien und Kroatien berichtet [3,4].…”