The Etiology of Community‐Acquired Pneumonia in Australia: Why Penicillin plus Doxycycline or a Macrolide Is the Most Appropriate Therapy

Charles, Patrick G P; Whitby, Michael; Fuller, Andrew; Stirling, Robert; Wright, A. A.; Korman, Tony M.; Holmes, Peter; Christiansen, Keryn; Waterer, Grant; Pierce, Robert J; Mayall, Barrie C.; Armstrong, John G.; Catton, Michael; Nimmo, Graeme R.; Johnson, Barbara; Hooy, Michelle; Grayson, M. L.

doi:10.1086/586749

Cited by 192 publications

(206 citation statements)

References 42 publications

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“…Using a cut-off titer of 1:16, a higher overall seropositivity of C. pneumoniae IgG was found in CAP patients compared with healthy controls. The IgG seropositivity in Jordanian CAP patients is considered one of the highest compared to rates reported previously for adult CAP populations in many regions of the world, which ranged from 50% to 70% [16,[29][30][31][32]. On the other hand, the rate of IgG detection in apparently healthy controls estimated here is analogous to overall C. pneumoniae seroprevalence previously recorded in healthy Jordanian adults [10,11].…”

Section: Discussionsupporting

confidence: 78%

Role of Chlamydia pneumoniae in community-acquired pneumonia in hospitalized Jordanian adults

Al-Aydie

Obeidat

Al-Younes

2016

J Infect Dev Ctries

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Introduction: This study investigated the role of Chlamydia pneumoniae in the etiology of community-acquired pneumonia (CAP) in Jordanian adults. Methodology: Eighty hospitalized CAP patients and 110 healthy adults were enrolled. Overall prevalences of C. pneumoniae IgG antibodies in sera and the rate of acute infection were estimated, using the microimmunofluorescence method (MIF), at titers of 1:16 and 1:512, respectively. Moreover, a nested polymerase chain reaction (PCR) was used to detect C. pneumoniae DNA in nasopharyngeal and blood Buffy coat samples. Results: Overall chlamydial IgG prevalence was higher in CAP cases than controls (70% versus 61.8%). Similarly, higher rate of acute infection was found in patients than in controls (16.3% versus 5.5%). By focusing on subjects testing positive at 1:16, acute infection was detectable in 23.2% of CAP cases, compared with 8.8% of seropositive controls. Chlamydial DNA was confirmed in 8.2% and 8.8% of nasopharyngeal specimens from controls and patients, respectively. Moreover, 10.9% and 7.5% of Buffy coats from controls and cases, respectively, were PCR-positive. When performances of both assays for detection of the pathogen were assessed, the sensitivities of MIF and PCR were low and comparable. However, MIF demonstrated higher specificity, positive predictive value, and negative predictive value than PCR. Conclusions: MIF-based data indicate that C. pneumoniae could be a potential causal agent of CAP in Jordan. This study may serve as a basis to elucidate the exact role C. pneumoniae and other co-infecting pathogens in the etiology of respiratory tract disease.

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Section: Discussionsupporting

confidence: 78%

Role of Chlamydia pneumoniae in community-acquired pneumonia in hospitalized Jordanian adults

Al-Aydie

Obeidat

Al-Younes

2016

J Infect Dev Ctries

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“…They were observational cohort studies except for one case-control study [34]. They were published between 2005 and 2015 and carried out in Europe (n=14) [1, 3, 5, 18-24, 26, 28, 33, 35], Asia (n=9) [2, 6, 10, 29-32, 34, 36], North America (n=4) [11,12,25,27], Oceania (n=3) [7,8,17] and South America (n=1) [9]. These studies enrolled a predominantly adult population although two of them used a cut-off of age >14 years for inclusion [3,31].…”

Section: Resultsmentioning

confidence: 99%

“…In patients with dual bacterial and viral infection (10 studies), the odds of death were significantly higher compared with patients without dual infection (OR 2. [3] SAITO [32] HOLM [22] JENNINGS [8] HOHENTHAL [21] CHARLES [17] JOHNSTONE [27] DIEDEREN [20] MERMOND [7] SHIBLI [34] JOHANSSON [26] LIEBERMAN [30] HARA [6] CILLÓNIZ [18] CHOI [2] SANGIL [33] YIN [36] VAN GAGELDONK-LAFEBER [5] LUCHSINGER [9] TAKAHASHI [10] WIEMKEN [11] MUSHER [12] VIASUS [35] HUIJSKENS [24] KIM [29] KARHU [28] HOLTER [23] QU [31] DAS [19] JAIN [25] …”

Section: Short-term Mortalitymentioning

confidence: 99%

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Viral infection in community-acquired pneumonia: a systematic review and meta-analysis

et al. 2016

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The advent of PCR has improved the identification of viruses in patients with communityacquired pneumonia (CAP). Several studies have used PCR to establish the importance of viruses in the aetiology of CAP.We performed a systematic review and meta-analysis of the studies that reported the proportion of viral infection detected via PCR in patients with CAP. We excluded studies with paediatric populations. The primary outcome was the proportion of patients with viral infection. The secondary outcome was short-term mortality.Our review included 31 studies. Most obtained PCR via nasopharyngeal or oropharyngeal swab. The pooled proportion of patients with viral infection was 24.5% (95% CI 21.5-27.5%). In studies that obtained lower respiratory samples in >50% of patients, the proportion was 44.2% (95% CI 35.1-53.3%). The odds of death were higher in patients with dual bacterial and viral infection (OR 2.1, 95% CI 1.32-3.31).Viral infection is present in a high proportion of patients with CAP. The true proportion of viral infection is probably underestimated because of negative test results from nasopharyngeal or oropharyngeal swab PCR. There is increased mortality in patients with dual bacterial and viral infection. @ERSpublications Viral infection is present in a high proportion of patients with community-acquired pneumonia

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“…Azithromycin (10 mg/kg/d) was added on the third day. After receiving this treatment, his leukocytes increased to 20,000 cells/mm 3 with ESR 97/h and CRP 22.5 mg/L. The β-lactam coverage was switched to cefuroxime and later to ceftriaxone because no response was observed.…”

Section: The Studymentioning

confidence: 99%

Macrolide Resistance inMycoplasma pneumoniae, Israel, 2010

Averbuch¹,

Hidalgo-Grass²,

Moses³

et al. 2011

Emerg. Infect. Dis.

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Macrolide resistance in Mycoplasma pneumoniae is often found in Asia but is rare elsewhere. We report the emergence of macrolide-resistant M. pneumoniae in Israel and the in vivo evolution of such resistance during the treatment of a 6-year-old boy with pneumonia.M ycoplasma pneumoniae is a leading respiratory pathogen in both pediatric (1,2) and adult (1,3) populations. Macrolides are considered the fi rst line of therapy and are almost the only treatment for children. In recent years, alarming rates of M. pneumoniae with macrolide resistance (<90%) have occurred in eastern Asia, including the People's Republic of China, Japan, and Korea (2,4-7). This was initially reported in children; however, a surge of resistance in adults was recently reported (2,4,7). Macrolide-resistant M. pneumoniae has also been suggested to be associated with a longer course of disease (2,4).In the Western Hemisphere, lower rates of macrolide resistance have been reported (<10%), however, several epidemics with notable complications have occurred (8)(9)(10)(11). We report the detection of macrolide resistance in M. pneumoniae in Israel. The StudyA previously healthy 6-year-old boy was hospitalized after 2 weeks with fever up to 40°C. At onset of illness, a diagnosis of pharyngitis was made. Streptococcus pyogenes was isolated from his throat, and amoxicillin was prescribed without any clinical response. Later, a clinical diagnosis of sinusitis was made, and amoxicillin-clavulanate was prescribed. A chest radiograph done at that time reportedly showed no abnormalities. Laboratory investigation before admission showed leukocytosis of 19,600 cells/mm 3 with 2,200 monocytes/mm 3 and 7,600 neutrophils/mm 3 ; L-lactate dehydrogenase (LDH) was 1,854 U/L (reference value up to 600 U/L).Ten days after the beginning of his illness, his fever decreased for 2 days and then reappeared, together with cough, resulting in hospitalization. At admission, pneumonia of the right middle and lower lobe was confi rmed by chest radiograph. Laboratory tests showed leukocytes within normal ranges, erythrocyte sedimentation rate (ESR) 80/h, and C-reactive protein (CRP) 15 mg/L (reference range up to 0.5 mg/L). Treatment with penicillin was started without clinical improvement. Azithromycin (10 mg/kg/d) was added on the third day. After receiving this treatment, his leukocytes increased to 20,000 cells/mm 3 with ESR 97/h and CRP 22.5 mg/L. The β-lactam coverage was switched to cefuroxime and later to ceftriaxone because no response was observed. Chest ultrasound showed a small pleural effusion. Bronchoscopy showed thick mucus secretions; respiratory specimens tested were negative for respiratory syncytial virus, infl uenza viruses A and B, parainfl uenza virus, human metapneumovirus, and adenovirus, as were results of urine tests for Legionella spp. and blood tests for pneumococcal antigen and cryptococcal antigen.Throat swab specimens were collected and DNA extracted by boiling. Samples were positive for M. pneumoniae by real-time PCR based on the detection of ...

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The Etiology of Community‐Acquired Pneumonia in Australia: Why Penicillin plus Doxycycline or a Macrolide Is the Most Appropriate Therapy

Cited by 192 publications

References 42 publications

Role of Chlamydia pneumoniae in community-acquired pneumonia in hospitalized Jordanian adults

Role of Chlamydia pneumoniae in community-acquired pneumonia in hospitalized Jordanian adults

Viral infection in community-acquired pneumonia: a systematic review and meta-analysis

Macrolide Resistance inMycoplasma pneumoniae, Israel, 2010

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