Chlamydia pneumoniae in community-acquired pneumonia.

Chlamydia pneumoniae has been established recently as an important human respiratory pathogen. The aim of this study was to define the prevalence of C. pneumoniae in community-acquired pneumonia. We prospectively investigated adult patients who were treated as inpatients and outpatients. Acute and convalescent serum samples were obtained from each patient. Serological diagnosis of C. pneumoniae infection was determined by enzyme-linked immunosorbent assay (ELISA). Eighty paired sera were tested for C. pneumoniae-specific IgM, IgG and IgA. Twenty-one patients (26.2%) had serological results compatible with acute C. pneumoniae infection. Eighteen (85.7%) of these infected patients were C. pneumoniae-specific IgM positive, three had a seroconversion of IgA and two had a four-fold or greater increase in C. pneumoniae-specific IgG antibody titer. The most common clinical manifestations of community-acquired pneumonia due to C. pneumoniae were fever (100%), cough (100%), chest pain (47.6%) and shortness of breath (42.9%). Physical examination revealed crackle in 85.7 per cent of the cases. These findings suggest that C. pneumoniae is a common cause of community-acquired pneumonia in Thailand.

Transbronchial needle aspiration in the diagnosis of bronchogenic carcinoma.

Transbronchial needle aspiration (TBNA) via a fiberoptic bronchoscope has been used for diagnosis of lung cancer by Wang since 1981. The technique uses a fiberoptic bronchoscope with a flexible needle that can penetrate the wall of the trachea and major bronchi. It is still underutilized and markedly depends on the physician's skill. We present our experience of TBNA for diagnosis of bronchogenic carcinoma. TBNA was performed on 47 consecutive patients with suspected lung cancer at the time of diagnosis bronchoscopy. Thirty six patients were diagnosed with bronchogenic carcinoma. TBNA demonstrated bronchogenic carcinoma in 61.1 per cent of the cases (22 of 36) and TBNA alone confirmed a malignant diagnosis in 33.3 per cent (12 of 36). The overall diagnostic yield of bronchoscope utilizing the conventional techniques of bronchial washing, brushings and biopsy was 50 per cent. With the addition of TBNA, bronchoscopy was diagnostic in 83.3 per cent of the patients. There were no serious complications. We concluded that TBNA is a safe technique that can significantly increase the diagnostic yield of conventional fiberoptic bronchoscopy in the diagnosis of bronchogenic carcinoma.