Causes of pneumonia presenting to a district general hospital.

Abstract

The incidence of bacterial, viral, mycoplasma, and rickettsial infections has been assessed prospectively in 210 adult patients with pneumonia who presented to a district hospital over a six-year period. One hundred and thirteen infective agents were detected in 103 patients. The agent most frequently detected was Mycoplasma pneumoniae which accounted for 30 infections. A bacterial pathogen was found in 43 patients. Streptococcus pneumoniae was the most common of these (24 patients); Staphylococcus aureus (eight), Haemophilus influenzae (four), Klebsiella spp (three), and Legionella pneumophila (three) were all less common. Chlamydial or rickettsial infections (Psittacosis or Q fever) were detected in nine patients. Viral infections were found in 31 patients (22 influenza A, four influenza B, two parainfluenza, and three respiratory syncytial virus). There were 10 patients in whom more than one pathogen was identified. In 107 patients no pathogens could be identified. Seventy-five per cent of these patients had either received antibiotics before entering hospital, or were unable to produce any sputum for culture. The incidence of bacterial pneumonia has probably therefore been underestimated. Nevertheless this survey does emphasise the importance of M pneumoniae as a pathogen in patients with pneumonia presenting to hospital.

Comparison of cefadroxil and cephalexin in the treatment of community-acquired pneumonia

“…However, past studies of community-acquired pneumonias have shown that preexisting chronic illnesses are common. Since individuals who develop pneumonia do not represent a cross section of the community, the distribution of chronic illness in this population approximates that reported previously (13,21).…”

Adult Community-Acquired Pneumonia in Central London

“…The presence of polymorph leukocytosis in 19 non-diagnosed cases suggests that pyogenic bacteria accounted for most of these pneumonias. None of 53 cases on whom paired samples were examined had positive Mycoplasma pneumoniae serology, in contrast to the Bristol study (White et al 1981) where Mycoplasma pneumoniae was the most common pathogen. The explanation for the absence of mycoplasma infection need not only be geographical.…”

“…In Nottingham (MacFarlane et al 1982) there were remarkably few cases (3%) without any microbial diagnosis, which may reflect the analysis of concentrated urine samples and necropsy lung material for pneumococcal antigen. Twenty-nine (36%) of our cases had no microbial diagnosis compared with 52% from the Bristol study (White et al 1981) where no test was performed for pneumococcal antigen. A previous hospital study (Spencer & Philp 1973) of pneumonia suggested that antibiotic prescribing by general practitioners influenced the number of undiagnosed cases.…”

“…Adult community-acquired pneumonia in central London' Introduction During the last few years reports from Nottingham (MacFarlane et al 1982) and Bristol (White et al 1981) have suggested a widely differing incidence of Streptococcus pneumoniae, Legionella pneumophila and Mycoplasma pneumoniae as causes of adult community-acquired pneumonia. The aim of this study was to investigate the microbial causes of communityacquired pneumonia in adults in central London requiring hospital admission, to document the clinical and laboratory findings associated with different microbial causes, and to define possible predisposing factors which may influence the outcome of treatment.…”

Legionnaires disease: historical perspective

“…On the other hand, inclusion of immunologic testing of sputum for pathogens that are also normal flora, such as Streptococcus pneumoniae, can also be criticized. In several series L. pneumophila has been a very common, if not the most common, cause of both communityacquired and nosocomially acquired pneumonia (169,266,279).…”