Atypical Pathogens as Etiologic Agents in Hospitalized Patients with Community-Acquired Pneumonia in Korea: A Prospective Multi-Center Study

Local epidemiologic data on the etiologies of patients hospitalized with community-acquired pneumonia (CAP) is needed to develop guidelines for clinical practice. This study was conducted prospectively to determine the proportion of atypical bacterial pathogens in adults patients hospitalized with CAP in Korea between October 2001 and December 2002. Microbiological diagnosis was determined by serology for antibodies to Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneu-mophila. Nucleic acid of M. pneumoniae and C. pneumoniae in respiratory samples and Legionella antigen in urine samples were detected. The study population consisted of 126 patients (71 males, 55 females), averaging 54.6 yr (SD+/-17.8), whose paired sera were available. An etiologic diagnosis for atypical pathogens was made in 18 patients (14.3%): C. pneumoniae 9 (7.1%), M. pneumoniae 8 (6.3%), and L. pneumophila 3 patients (2.4%). Streptococcus preumoniae and other typical pathogens were isolated from 36 patients (28.6%). Of 126 patients, 16 (12.7%) were admitted to intensive care unit and atypical pathogens were identified in 5 patients (31.3%). Initial clinical features of patients with pneumonia due to atypical, typical or undetermined pathogens were indistinguishable. We conclude that atypical pathogens should be seriously considered in hospitalized patients with CAP, when initiating empiric treatment in Korea.

Neumonía adquirida en la comunidad: comunicación de 8 casos de neumonía grave por legionella pneumophila serogrupo 1 en Chile / Community acquired pneumonia: report of 8 cases of severe pneumonia caused by legionella pneumophila seroproup 1 in Chile

Legionella pneumophila is the second cause of severe community acquired pneumonia. In Chile, however, there are few reports of pneumonia caused by Legionella. We report eight patients (6 men, aged 42 to 72 years old) with community-acquired pneumonia caused by Legionella pneumophila serogroup 1, confirmed by the measurement of urinary antigen. Clinical presentation was characterized by fever or hypothermia (in one case), cough, dyspnea and neurological abnormalities in four patients. Cigarette smoking was the most frequently identified risk factor. All patients had at least one American Thoracic Society severity criteria. Complications observed were acute hypoxemic respiratory failure in seven patients, shock in four, renal failure in four and need for mechanical ventilation in three. No patient died

Serum and urinary bacterial antigens in cases of acute bacterial lobar pneumonia in children

The aim of this study was to assess the presence of Str. pneumonia and H. influenzae capsular antigens in serum and urine of children with acute lobar pneumonia. To fulfill this, 20 children diagnosed clinically and radiologically as lobar pneumonia selected from El-Shatby Children's Hospital, were included in this study. Latex particle agglutination method was used to identify Str. pneumoniae and H. influenzae capsular antigens in the urine and serum of these children. This method was compared with nasopharyngeal culture. Antigenuria was found in 50% of children compared with 80% of positive nasopharyngeal culture result. Antigenemia was found in 85% of children. So, bacterial antigen detection in urine by latex particle agglutination test appears to be a useful tool for etiologic diagnosis of bacterial pneumonia. It is easier, more rapid than the st and ard culture methods, especially in severely ill patients receiving prior antibiotic therapy

Deteccao de antigenos bacterianos em pneumonia aguda: metodos de preparacao das amostras de urina, soro e liquido pleural para os testes de imunodiagnostico / Detection of bacterial antigens in acute pneumonia: methods of preparing the urine, serum and pleural fluid samples for immunodiagnostic assays

Foi desenvolvido um metodo de precipitacao de antigenos polissacaridicos de S. pneumoniae e H influenzae tipo b na urina, atraves do tratamento com uma solucao de etnol-acetona 1:1 seguido de um tratamento a quente com EDTA 0,1M. Foram empregadas as tecnicas de contra-imunoeletroforese e latex aglutinacao para a deteccao de antigenos polissacarideos em amostras pareadas de urina e soro e ainda de liquido pleural, de criancas com diagnostico clinico e radiologico de pneumonia aguda. Contra-imunoeletroforese e latex aglutinacao apresentaram melhores indices de sensibilidade em urina do que em soro e tiveram otimo desempenho tanto para urina de volume inicial relativamente pequeno como de grande volume, colhidas antes ou durante os primeiros dias de antibioticoterapia. Os resultados obtidos em contra-imunoeletroforese e latex aglutinacao mostraram que a solucao etanol-acetona 1:1 fornece melhor rendimento na precipitacao de antigeno polissacaridico enquanto que o aquecimento com EDTA diminui a probabilidade de ocorrencia de resultados falso-positivos e de reatividade cruzada entre S. pneumoniae e H. influenzae tipo b. A urina mostrou-se como importante meio de deteccao de antigenos bacterianos no diagnostico de pneumonia bacteriana aguda, principalmente se a antibioticoterapia previa obstrui o crescimento bacteriano nos meios de cultura.

Etiología de las infecciones agudas del tracto respiratorio bajo en lactantes hospitalizados: antígenos bacterianos / Etiology of acute infections of the lower respiratory tract in hospitalized infants: bacterial antigens

La detección de antígenos bacterianos en distintos fluidos corporales ha sido usada como método de detección de infecciones bacterianas, demostrándose recientemente mayor positividad en orina concentrada en relación al suero. Se presenta la técnica de detección de antígenos bacterianos por aglutinación por látex, en orina concentrada 50 veces mediante un sistema de ultrafiltrado Minicom y el uso de antisuero Bactigen para Haemophilus influenzae y Streptococcus pneumoniae. Se describe la participación de estos agentes en las IRAB del lactante menor de 1 año hospitalizado. Se estudian 3 grupos: Grupo A (control positivo): 7 casos, todos con aglutinación positiva. Grupo B (controles sanos): 3/16 con aglutinación positiva sólo para Haemophilus influenzae. Grupo C (pacientes con IRAB): 10/77 casos con aglutinación positiva a Haemophilus influenzae y sólo 2/77 positivos a Streptococcus pneumoniae. Se presenta un nuevo método de diagnóstico precoz, el que sugiere en forma preliminar que la obtención de antígenos en orina es un método útil en el diagnóstico etiológico de infecciones bacterianas y que el hallazgo de Streptococcus pneumoniae sería escaso en los lactantes menores de 1 año con IRAB. Se discute el hallazgo predominante de Haemophilus influenzae

Detection of leprosy antigenuria through DOT-ELISA.

Fifty-five samples of urine from different grades of leprosy patients and normal persons were processed for detection of PGL-1 antigen through DOT-ELISA on nitrocellulose paper strips using anti-human IgG horse raddish peroxidaseconjugate. About 66.6% of the paucibacillary and 100% of the multibacillary leprosy cases were detectable through this technique on the basis of differential colour development on the strips. Possibility of its use in the field conditions has been discussed.