Etiology of Community-Acquired Pneumonia

Marrie, Thomas J.

doi:10.1007/0-306-46834-4_8

Cited by 26 publications

(54 citation statements)

References 39 publications

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“…However, the present PCR protocol is unique, as it is constructed for identification of two typical and two atypical pathogens, probably the four most common aetiologies of CAP [38].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a multiplex PCR for bacterial pathogens applied to bronchoalveolar lavage

Strålin

Korsgaard²,

Olcén³

2006

Eur Respir J

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The present study assessed the diagnostic usefulness of a multiplex PCR (mPCR) for Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae and Chlamydophila pneumoniae applied to bronchoalveolar lavage (BAL).Fibreoptic bronchoscopy was performed on 156 hospitalised adult patients with lower respiratory tract infection (LRTI) and 36 controls. BAL fluid was analysed with bacterial culture and mPCR.By conventional diagnostic methods, S. pneumoniae, H. influenzae, M. pneumoniae and C. pneumoniae were aetiological agents in 14, 21, 3.2 and 0% of the LRTI patients, respectively. These pathogens were identified by BAL mPCR in 28, 47, 3.2 and 0.6% of cases, respectively, yielding sensitivities of 86% for S. pneumoniae, 88% for H. influenzae, 100% for M. pneumoniae and 0% for C. pneumoniae, and specificities of 81, 64, 100 and 99% for S. pneumoniae, H. influenzae, M. pneumoniae and C. pneumoniae, respectively. Of the 103 patients who had taken antibiotics prior to bronchoscopy, S. pneumoniae was identified by culture in 2.9% and by mPCR in 31%. Among the controls, mPCR identified S. pneumoniae in 11% and H. influenzae in 39%.In lower respiratory tract infection patients, bronchoalveolar lavage multiplex PCR can be useful for identification of Streptococcus pneumoniae, Mycoplasma pneumoniae and Chlamydophila pneumoniae. The method appears to be particularly useful in patients treated with antibiotics.

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“…However, the present PCR protocol is unique, as it is constructed for identification of two typical and two atypical pathogens, probably the four most common aetiologies of CAP [38].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a multiplex PCR for bacterial pathogens applied to bronchoalveolar lavage

Strålin

Korsgaard²,

Olcén³

2006

Eur Respir J

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“…As an etiologic agent can rarely be identified in more than 50% of patients with community-acquired pneumonia (CAP) (9), further development of diagnostic methods has been encouraged (4,10).…”

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confidence: 99%

Etiologic Diagnosis of Adult Bacterial Pneumonia by Culture and PCR Applied to Respiratory Tract Samples

Strålin¹,

Tornqvist

Kaltoft

et al. 2006

J Clin Microbiol

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Respiratory culture and multiplex PCR for Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, and Chlamydophila pneumoniae were applied to sputum, nasopharyngeal swabs, and nasopharyngeal aspirates from 235 adult patients with community-acquired pneumonia and 113 controls. Both culture and multiplex PCR performed well with the different samples and appear to be useful as diagnostic tools.As an etiologic agent can rarely be identified in more than 50% of patients with community-acquired pneumonia (CAP) (9), further development of diagnostic methods has been encouraged (4, 10).The aim of the present study was to estimate the diagnostic accuracy of respiratory culture and a single-run multiplex PCR (mPCR) for specific genes of Streptococcus pneumoniae (lytA), Haemophilus influenzae (16S rRNA, with verification by PCR for P6), Mycoplasma pneumoniae (P1), and Chlamydophila pneumoniae (ompA) (12) applied to respiratory samples in CAP patients.(The study was approved by the ethics committee of the Ö rebro County Council [868-1999; 556-2000].)In a prospective study described previously (14), 235 hospitalized CAP patients with X-ray infiltrates were enrolled. Their median age was 71 years (age range, 18 to 96 years), 40% belonged to severity risk classes IV and V, 14% had chronic obstructive pulmonary disease, and 22% were smokers. In 82% of the patients, the interval from the onset of illness to admission was 0 to 7 days.During the study period, 113 adult controls (median age, 69 years) without respiratory symptoms were enrolled. They were hospitalized for skin infection (n ϭ 14), urinary tract infection (n ϭ 14), arthritis or spondylitis (n ϭ 6), or planned orthopedic or urological surgery (n ϭ 79).The results of the respiratory cultures and mPCR analyses performed with specimens from the patients and the controls are shown in Table 1. Sputum samples were analyzed if there were more than five leukocytes per squamous epithelial cell (6). To obtain a nasopharyngeal aspirate (NpA), secretions from the nasopharynx were aspirated by a catheter connected to an electronic suction device. About 1 ml NaCl (0.85%) was then aspirated to collect the secretions situated within the catheter. Culture and mPCR of sputum, nasopharyngeal swabs (NpSs), and NpAs were performed as described previously (12). Multiplex PCR was performed blindly with samples previously frozen at Ϫ70°C.To establish the definite etiologies of CAP, we performed the following: blood culture for 235 patients, the NOW S. pneumoniae urinary antigen test (Binax) for 215 patients, the complement fixation test for M. pneumoniae (8) with paired serum specimens for 216 patients, the microimmunofluorescence test for C. pneumoniae (3) with paired serum specimens for 216 patients, and the indirect immunofluorescence test for H. influenzae (13) with paired serum specimens for 48 patients. Our criteria for definite CAP etiologies were as follows: for S. pneumoniae, a positive blood culture or a positive urinary antigen test (only visible result lines at l...

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“…6 However, recovery as defined by chest radiography is an imperfect standard and has not been routinely correlated with clinically meaningful variation in outcomes. 7 Alternatively, recovery can be measured based on patient reported health status, but the published literature lacks any instruments to specifically measure recovery from pneumonia. Although generic instruments, such as the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), are available, they are theoretically less responsive to variations in disease outcomes than specific instruments, in part because specific instruments include only those items that are relevant to the disease under study.…”

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confidence: 99%

Measuring symptomatic and functional recovery in patients with community-acquired pneumonia

et al. 1997

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OBJECTIVE:To determine the rates of resolution of symptoms and return to premorbid health status and assess the association of these outcomes with health care utilization in patients with community-acquired pneumonia. DESIGN:A prospective, multicenter cohort study.SETTING: Inpatient and outpatient facilities at three university hospitals, one community hospital, and one staff-model health maintenance organization. PATIENTS:Five hundred seventy-six adults (aged Ն 18 years) with clinical and radiographic evidence of pneumonia, judged by a validated pneumonia severity index to be at low risk of dying. MEASUREMENTS AND MAIN RESULTS:The presence and severity of five symptoms (cough, fatigue, dyspnea, sputum, and chest pain) were recorded through questionnaires administered at four time points: 0, 7, 30, and 90 days from the time of radiographic diagnosis of pneumonia. A summary symptom score was tabulated as the sum of the five individual severity scores. Patients also provided responses to the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and reported the number of and reason for outpatient physician visits. Symptoms and health status 30 days before pneumonia onset (prepneumonia) were obtained at the initial interview. All symptoms, except pleuritic chest pain, were still commonly reported at 30 days, and the prevalence of each symptom at 90 days was still nearly twice prepneumonia levels. Physical health measures derived from the SF-36 Form declined significantly at presentation but continued to improve over all three follow-up time periods. Patients with elevated symptom scores at day 7 or day 30 were significantly more likely to report pneumonia-related ambulatory care visits at the subsequent day 30 or day 90 interviews, respectively.CONCLUSIONS: Disease-specific symptom resolution and recovery of the premorbid physical health status requires more than 30 days for many patients with pneumonia. Delayed resolution of symptoms is associated with increased utilization of outpatient physician visits.

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Etiology of Community-Acquired Pneumonia

Cited by 26 publications

References 39 publications

Evaluation of a multiplex PCR for bacterial pathogens applied to bronchoalveolar lavage

Evaluation of a multiplex PCR for bacterial pathogens applied to bronchoalveolar lavage

Etiologic Diagnosis of Adult Bacterial Pneumonia by Culture and PCR Applied to Respiratory Tract Samples

Measuring symptomatic and functional recovery in patients with community-acquired pneumonia

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