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Lapi F, Domnich A, Marconi E, Cricelli I, Rossi A, Icardi G, Cricelli C. Supporting vaccine (co)-administration decisions: Development and validation of a tool for assessing the risk of severe outcomes due to lower respiratory tract infections. Respir Med 2024; 232:107761. [PMID: 39117010 DOI: 10.1016/j.rmed.2024.107761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 08/01/2024] [Accepted: 08/02/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To develop and validate a score to predict the 90-day risk of hospitalization/death in patients with low respiratory tract infections (LRTIs) with the aim to support clinical decision making on vaccine (co)-administration. METHODS We formed a cohort of patients aged 18 years or older being diagnosed with LRTIs in the period between January 1, 2012 and December 31, 2022. Each patient was followed until occurrence of respiratory-related hospitalization/death up to the end of the study period (December 31, 2022). Along with age and sex, forty determinants were adopted to assemble the respiratory tract infection (RTI)-Health Search (HS) core using the development sub-cohort. The prediction accuracy of the score was therefore assessed in the validation sub-cohort. RESULTS We identified 252,319 patients being diagnosed with LRTIs (females: 54.7 %; mean age: 60 (SD:18.1)). When the risk of LRTIs-related hospitalizations/deaths was estimated via RTI-HScore, its predicted value was equal to 1.4 % over a 90-day event horizon. The score showed explained variation and discrimination accuracy were equal to 45 % (95 % CI: 44-47 %) and 81 % (95 % CI: 79-84 %), respectively. The calibration slope did not significantly differ from the unit (p = 0.8314). CONCLUSIONS The RTI-HScore was featured by good accuracy for prediction of LRTIs-related complications over a 90-day follow-up. Such a tool might therefore support general practitioners to enhance patients' care by facilitating approaches for (co)-administration of vaccines for respiratory infections through a score-based decision support system.
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Affiliation(s)
- Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy.
| | - Alexander Domnich
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Ettore Marconi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | | | - Alessandro Rossi
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Giancarlo Icardi
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
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Epidemiology of Community-Acquired Respiratory Tract Infections in Patients Admitted at the Emergency Departments. Trop Med Infect Dis 2022; 7:tropicalmed7090233. [PMID: 36136644 PMCID: PMC9501977 DOI: 10.3390/tropicalmed7090233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/23/2022] [Accepted: 09/01/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives: Community-acquired respiratory infections (CARTIs) are responsible for serious morbidities worldwide. Identifying the aetiology can decrease the use of unnecessary antimicrobial therapy. In this study, we intend to determine the pathogenic agents responsible for respiratory infections in patients presenting to the emergency department of several Lebanese hospitals. Methods: A total of 100 patients presenting to the emergency departments of four Lebanese hospitals and identified as having CARTIs between September 2017 and September 2018 were recruited. Specimens of upper and lower respiratory tract samples were collected. Pathogens were detected by a multiplex polymerase chain reaction respiratory panel. Results: Of 100 specimens, 84 contained at least one pathogen. Many patients were detected with ≥2 pathogens. The total number of pathogens from these 84 patients was 163. Of these pathogens, 36 (22%) were human rhinovirus, 28 (17%) were Streptococcus pneumoniae, 16 (10%) were metapneumovirus, 16 (10%) were influenza A virus, and other pathogens were detected with lower percentages. As expected, the highest occurrence of pathogens was observed between December and March. Respiratory syncytial virus accounted for 2% of the cases and only correlated to paediatric patients. Conclusion: CARTI epidemiology is important and understudied in Lebanon. This study offers the first Lebanese data about CARTI pathogens. Viruses were the most common aetiologies of CARTIs. Thus, a different approach must be used for the empirical management of CARTI. Rapid testing might be useful in identifying patients who need antibiotic therapy.
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Review of Method and a New Tool for Decline and Inactive SARS-CoV-2 in Wastewater Treatment. CLEANER CHEMICAL ENGINEERING 2022. [PMCID: PMC9213033 DOI: 10.1016/j.clce.2022.100037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Following the recent outbreak of the COVID-19 pandemic caused by the SARS-CoV-2 virus, monitoring sewage has become crucial, according to reports that the virus was detected in sewage. Currently, various methods are discussed for understanding the SARS-CoV-2 using wastewater surveillance. This paper first introduces the fundamental knowledge of primary, secondary, and tertiary water treatment on SARS-CoV-2. Next, a thorough overview is presented to summarize the recent developments and breakthroughs in removing SARS-CoV-2 using solar water disinfection (SODIS) and UV (UVA (315–400 nm), UVB (280-315 nm), and UVC (100–280 nm)) process. In addition, Due to the fact that the distilled water can be exposed to sunlight if there is no heating source, it can be disinfected using solar water disinfection (SODIS). SODIS, on the other hand, is a well-known method of reducing pathogens in contaminated water; moreover, UVC can inactivate SARS-CoV-2 when the wavelength is between 100 to 280 nanometers. High temperatures (more than 56°C) and UVC are essential for eliminating SARS-CoV-2; however, the SODIS systems use UVA and work at lower temperatures (less than45°C). Therefore, using SODIS methods for wastewater treatment (or providing drinking water) is not appropriate during a situation like the ongoing pandemic. Finally, a wastewater-based epidemiology (WBE) tracking tool for SARS-CoV-2 can be used to detect its presence in wastewater.
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Verheij TJ, Cianci D, van der Velden AW, Butler CC, Bongard E, Coenen S, Colliers A, Francis NA, Little P, Godycki-Cwirko M, Llor C, Chlabicz S, Lionis C, Sundvall PD, Bjerrum L, De Sutter A, Aabenhus R, Harbin NJ, Lindbæk M, Glinz D, Bucher HC, Kovács B, Seifert B, Jurgute RR, Lundgren PT, de Paor M, Matheeussen V, Goossens H, Ieven M. Clinical presentation, microbiological aetiology and disease course in patients with flu-like illness: a post hoc analysis of randomised controlled trial data. Br J Gen Pract 2022; 72:e217-e224. [PMID: 34990385 PMCID: PMC8803087 DOI: 10.3399/bjgp.2021.0344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/04/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND There is little evidence about the relationship between aetiology, illness severity, and clinical course of respiratory tract infections (RTIs) in primary care. Understanding these associations would aid in the development of effective management strategies for these infections. AIM To investigate whether clinical presentation and illness course differ between RTIs where a viral pathogen was detected and those where a potential bacterial pathogen was found. DESIGN AND SETTING Post hoc analysis of data from a pragmatic randomised trial on the effects of oseltamivir in patients with flu-like illness in primary care (n = 3266) in 15 European countries. METHOD Patient characteristics and their signs and symptoms of disease were registered at baseline. Nasopharyngeal (adults) or nasal and pharyngeal (children) swabs were taken for polymerase chain reaction analysis. Patients were followed up until 28 days after inclusion. Regression models and Kaplan-Meier curves were used to analyse the relationship between aetiology, clinical presentation at baseline, and course of disease including complications. RESULTS Except for a less prominent congested nose (odds ratio [OR] 0.55, 95% confidence interval [CI] = 0.35 to 0.86) and acute cough (OR 0.42, 95% CI = 0.27 to 0.65) in patients with flu-like illness in whom a possible bacterial pathogen was isolated, there were no clear clinical differences in presentations between those with a possible bacterial aetiology compared with those with a viral aetiology. Also, course of disease and complications were not related to aetiology. CONCLUSION Given current available microbiological tests and antimicrobial treatments, and outside pandemics such as COVID-19, microbiological testing in primary care patients with flu-like illness seems to have limited value. A wait-and-see policy in most of these patients with flu-like illness seems the best option.
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Affiliation(s)
- Theo J Verheij
- Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daniela Cianci
- Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alike W van der Velden
- Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Christopher C Butler
- Nuffield Department of Primary Care, University of Oxford Medical Sciences Division, Oxford, UK
| | - Emily Bongard
- Nuffield Department of Primary Care, University of Oxford Medical Sciences Division, Oxford, UK
| | - Samuel Coenen
- Department of Primary and Interdisciplinary Care (ELIZA) - Centre for General Practice, University of Antwerp Faculty of Medicine and Health Sciences, Antwerp, Belgium
| | - Annelies Colliers
- Department of Primary and Interdisciplinary Care (ELIZA) - Centre for General Practice, University of Antwerp Faculty of Medicine and Health Sciences, Antwerp, Belgium
| | - Nick A Francis
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Paul Little
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Maciek Godycki-Cwirko
- Division of Public Health, Centre for Family and Community Medicine, Medical University of Lodz, Lodz, Poland
| | - Carl Llor
- University of Copenhagen, Copenhagen, Denmark; University Institute in Primary Care Research Jordi Gol, Via Roma Health Centre, Barcelona, Spain
| | - Sławomir Chlabicz
- Department of Family Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Christos Lionis
- Clinic of Social and Family Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Pär-Daniel Sundvall
- Research and Development Primary Health Care, Västra Götalandsregionen, University of Gothenburg; Sahlgrenska Academy, Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Gothenburg, Sweden
| | | | - An De Sutter
- Department of Public Health and Primary Care, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | | | - Nicolay Jonassen Harbin
- Antibiotic Center for Primary Care, Department of General Practice, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Morten Lindbæk
- Antibiotic Center for Primary Care, Department of General Practice, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Dominik Glinz
- Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Heiner C Bucher
- Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | | | - Bohumil Seifert
- Department of General Practice, Charles University, Prague, Czech Republic
| | | | - Pia Touboul Lundgren
- Départment de Santé Publique, Université Côte d'Azur Faculté de Médecine, Nice, France
| | | | - Veerle Matheeussen
- Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute, University Hospital Antwerp, Antwerp, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute, University Hospital Antwerp, Antwerp, Belgium
| | - Margareta Ieven
- Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute, University Hospital Antwerp, Antwerp, Belgium
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Dong Y, Lv W, Lin Z. Value of serum Mycoplasma pneumoniae immunoglobulin in the diagnosis of mycoplasma-related pneumonia in newborns. Exp Ther Med 2017; 14:1445-1449. [PMID: 28810609 PMCID: PMC5525573 DOI: 10.3892/etm.2017.4654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/02/2017] [Indexed: 11/12/2022] Open
Abstract
Mycoplasma pneumoniae (M. pneumoniae) is an important pathogen of neonatal acquired pneumonia in newborns. Rapid and accurate diagnosis of M. pneumoniae infection is critical because timely antibiotic therapy can reduce drug overuse and prevent the development of bacterial resistance. Anti-M. pneumoniae immunoglobulin M (IgM) is an indicator of early infection that can persist for several months. Studies have shown that anti-M. pneumoniae IgA in adults is a reliable indicator of early M. pneumoniae infection. The aim of this study was to assess the association between M. pneumoniae IgA, IgM and IgG in mycoplasma-associated pneumonia. We recruited 80 newborns with pneumonia with potency of serum M. pneumoniae IgM positive or two sera anti-M. pneumoniae IgG increased by 4-fold. The potency of serum M. pneumoniae IgA, IgM and IgG were detected. The initial positive rates of IgM and IgA in M. pneumoniae were 63.6 and 33.8%, respectively, after infection. The positive rate of IgM and IgA in M. pneumoniae increased to 97.5 and 56.3%, respectively, at one week after infection. Compared with anti-M. pneumoniae IgA, anti-M. pneumoniae IgM has higher sensitivity in the diagnosis of neonatal mycoplasma-associated pneumonia. Detection of two sera can more effectively improve the diagnostic accuracy.
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Affiliation(s)
- Yan Dong
- Department of Paediatrics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201900, P.R. China
| | - Wei Lv
- Department of Paediatrics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201900, P.R. China
| | - Zhen Lin
- Department of Paediatrics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201900, P.R. China
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Mayer LM, Kahlert C, Rassouli F, Vernazza P, Albrich WC. Impact of viral multiplex real-time PCR on management of respiratory tract infection: a retrospective cohort study. Pneumonia (Nathan) 2017; 9:4. [PMID: 28702306 PMCID: PMC5471894 DOI: 10.1186/s41479-017-0028-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 01/18/2017] [Indexed: 01/15/2023] Open
Abstract
Background Significance and clinical utility of multiple virus detection by multiplex real-time polymerase chain reaction (rtPCR) in respiratory tract infection remain unclear. Methods This retrospective cohort study analyzed how virus detection affected clinical management. During a 27-month period, clinical and laboratory information was collected from all children and adults in two Swiss tertiary centres whose respiratory samples were tested for respiratory viruses with a 16-plex rtPCR test. Results Pathogens were identified in 140 of 254 patients (55%); of those patients, there was ≥1 virus in 91 (65%), ≥ 1 bacterium in 53 (38%), and ≥1 virus and bacterium in 11 (8%). Of 80 patients with viral infection, 59 (74%) received antibiotics. Virus detection was associated with discontinuation of antibiotics in 2 of 20 adults (10%) and 6 of 14 children (43%). Overall 12 adults (34%) and 18 children (67%) were managed correctly without antibiotics after virus detection (p = 0.01). When taking biomarkers, radiologic presentations, and antibiotic pre-treatment into account, the impact of rtPCR and appropriateness of therapy for clinically viral infections increased to 100% in children and 62% in adults. Conclusions A substantial reduction of unnecessary antibiotic prescriptions seems possible. Appropriate application of rtPCR results in respiratory tract infections should be encouraged.
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Affiliation(s)
- Lena M Mayer
- School of Medicine, University of Basel, Klingelbergstasse 61, 4056 Basel, Switzerland.,Division of Infectious Diseases & Hospital Epidemiology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
| | - Christian Kahlert
- Children's Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006 St. Gallen, Switzerland.,Division of Infectious Diseases & Hospital Epidemiology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
| | - Frank Rassouli
- Clinic for Pulmonology & Sleep Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
| | - Pietro Vernazza
- Division of Infectious Diseases & Hospital Epidemiology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
| | - Werner C Albrich
- Division of Infectious Diseases & Hospital Epidemiology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
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Role of Serum Mycoplasma pneumoniae IgA, IgM, and IgG in the Diagnosis of Mycoplasma pneumoniae-Related Pneumonia in School-Age Children and Adolescents. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2017; 24:CVI.00471-16. [PMID: 27760779 DOI: 10.1128/cvi.00471-16] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 10/07/2016] [Indexed: 01/10/2023]
Abstract
Mycoplasma pneumoniae is an important causative pathogen of community-acquired pneumonia in children. Rapid and reliable laboratory diagnosis of M. pneumoniae infection is important so that appropriate antibiotic treatment can be initiated to reduce the misuse of drugs and resistance rates. Anti-M. pneumoniae immunoglobulin M (IgM) is an indicator of recent primary infection but can persist for several months after initial infection. It has been suggested that anti-M. pneumoniae immunoglobulin A (IgA) can be a reliable indicator for recent M. pneumoniae infection in adults. We investigated the clinical diagnostic value of M. pneumoniae IgA in school-age children and adolescents with M. pneumoniae-related pneumonia. Eighty children with pneumonia and seropositive for M. pneumoniae IgM or with a 4-fold increase of anti-M. pneumoniae immunoglobulin G (IgG) were enrolled from May 2015 to March 2016. The titers of M. pneumoniae IgA, IgM, and IgG, the clinical features, and laboratory examinations of blood, C-reactive protein, and liver enzymes were analyzed. The initial positivity rates for M. pneumoniae IgM and IgA upon admission to the hospital were 63.6 and 33.8%, respectively. One week after admission, the cumulative positivity rates for M. pneumoniae IgM and IgA increased to 97.5 and 56.3%, respectively. Detection of M. pneumoniae IgM was more sensitive than detection of M. pneumoniae IgA for the diagnosis of M. pneumoniae-related pneumonia in school-age children and adolescents; however, paired sera are necessary for a more accurate diagnosis.
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Park JY, Park S, Lee SH, Lee MG, Park YB, Oh KC, Lee JM, Kim DI, Seo KH, Shin KC, Yoo KH, Ko Y, Jang SH, Jung KS, Hwang YI. Microorganisms Causing Community-Acquired Acute Bronchitis: The Role of Bacterial Infection. PLoS One 2016; 11:e0165553. [PMID: 27788254 PMCID: PMC5082923 DOI: 10.1371/journal.pone.0165553] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 10/13/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although acute bronchitis is quite common, there is relatively limited information regarding the microorganisms that are involved in this illness. METHODS We performed a prospective study of acute bronchitis at 31 hospitals and clinics in Korea from July 2011 to June 2012. Sputum specimens were collected for polymerase chain reaction (PCR) and culture of microorganisms. RESULTS Of the 811 enrolled patients, 291 had acceptable sputum specimens that were included for analysis of the etiologic distribution. With multiplex PCR testing, viruses were identified in 36.1% (105/291), most commonly rhinovirus (25.8%) and coronavirus (3.8%). Typical bacteria were isolated in 126/291 (43.3%) patients. Among these patients Haemophilus influenzae (n = 39) and Streptococcus pneumoniae (n = 30) were isolated most commonly; atypical bacteria were identified in 44 (15.1%) patients. Bacteria-only, virus-only, and mixed infections (bacteria plus virus) accounted for 36.7% (98/291), 17.2% (50/291), and 18.9% (55/291) of infections, respectively. In particular, 52.4% of patients with viral infection had a concurrent bacterial infection, and rhinovirus was the most common virus in mixed infections (40/55). Additionally, infections with typical bacteria were more common in patients with chronic lung disease (p = 0.029), and typical bacterial infections showed a trend towards a higher prevalence with older age (p = 0.001). CONCLUSIONS Bacteria were associated with almost half of community-acquired acute bronchitis cases. Additional studies are required to further illuminate the role of bacteria and to identify patient groups most likely to benefit from antibiotic treatment.
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Affiliation(s)
- Ji Young Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Sunghoon Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Sun Hwa Lee
- Seegene Medical Foundation, Seoul, Republic of Korea
| | - Myung Goo Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea
| | - Yong Bum Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Kil Chan Oh
- Myeongmun Clinic of Internal Medicine, Yongin, Republic of Korea
| | - Jae-Myung Lee
- Leejaemyung Clinic of Internal Medicine, Anyang, Republic of Korea
| | - Do Il Kim
- Rapha Clinic of Otolaryngology, Anyang, Republic of Korea
| | - Ki-Hyun Seo
- Division of Pulmonary and Critical Care Medicine, Soonchunhyang University Hospital, Cheonan, Republic of Korea
| | - Kyeong-Cheol Shin
- Division of Pulmonary, Allergy and Critical Care Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Kwang Ha Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Konkuk University Hospital, Seoul, Republic of Korea
| | - Yongchun Ko
- Division of Pulmonary Medicine, Gwangju Christian Hospital, Gwangju, Republic of Korea
| | - Seung Hun Jang
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Ki-Suck Jung
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Yong Il Hwang
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
- * E-mail:
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Park S, Oh KC, Kim KS, Song KT, Yoo KH, Shim YS, Lee YJ, Lee MG, Yun JU, Kim HS, Kim YH, Lee WJ, Kim DI, Cha HG, Lee JM, Seo JS, Jung KS. Role of Atypical Pathogens and the Antibiotic Prescription Pattern in Acute Bronchitis: A Multicenter Study in Korea. J Korean Med Sci 2015; 30:1446-52. [PMID: 26425041 PMCID: PMC4575933 DOI: 10.3346/jkms.2015.30.10.1446] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 07/01/2015] [Indexed: 12/02/2022] Open
Abstract
The role of atypical bacteria and the effect of antibiotic treatments in acute bronchitis are still not clear. This study was conducted at 22 hospitals (17 primary care clinics and 5 university hospitals) in Korea. Outpatients (aged ≥ 18 yr) who had an acute illness with a new cough and sputum (≤ 30 days) were enrolled in 2013. Multiplex real-time polymerase chain reaction (RT-PCR) was used to detect five atypical bacteria. A total of 435 patients were diagnosed as having acute bronchitis (vs. probable pneumonia, n = 75), and 1.8% (n = 8) were positive for atypical pathogens (Bordetella pertussis, n = 3; B. parapertussis, n = 0; Mycoplasma pneumoniae, n = 1; Chlamydophila pneumoniae, n = 3; Legionella pneumophila, n = 1). Among clinical symptoms and signs, only post-tussive vomiting was more frequent in patients with atypical pathogens than those without (P = 0.024). In all, 72.2% of the enrolled patients received antibiotic treatment at their first visits, and β-lactams (29.4%) and quinolones (20.5%) were the most commonly prescribed agents. In conclusion, our study demonstrates that the incidence of atypical pathogens is low in patients with acute bronchitis, and the rate of antibiotic prescriptions is high.
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Affiliation(s)
- Sunghoon Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kil Chan Oh
- Myeongmun Clinic of Internal Medicine, Yongin, Korea
| | - Ki-Seong Kim
- Joeun Clinic of Internal Medicine, Dangjin, Korea
| | - Kyu-Tae Song
- Neulpurun Clinic of Otolaryngology, Anyang, Korea
| | - Kwang Ha Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Konkuk University Hospital, Seoul, Korea
| | - Yun Su Shim
- Division of Pulmonary, Allergy and Critical Care Medicine, Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Young Ju Lee
- Pyeongchon-Family Clinic of Internal Medicine, Anyang, Korea
| | - Myung Goo Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Jang Uk Yun
- Haengbok-Dream Clinic of Internal Medicine, Daegu, Korea
| | - Hyun Su Kim
- Hanyang Clinic of Internal Medicine, Seoul, Korea
| | - Yee Hyung Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Kyung Hee University, Seoul, Korea
| | - Won Jun Lee
- Hongjunggon Clinic of Internal Medicine, Anyang, Korea
| | - Do Il Kim
- Rapha Clinic of Otolaryngology, Anyang, Korea
| | | | - Jae-Myung Lee
- Leejaemyung Clinic of Internal Medicine, Anyang, Korea
| | - Jung San Seo
- Seojungsan Clinic of Internal Medicine, Seoul, Korea
| | - Ki-Suck Jung
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
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Meeraus WH, Petersen I, Gilbert R. Association between antibiotic prescribing in pregnancy and cerebral palsy or epilepsy in children born at term: a cohort study using the health improvement network. PLoS One 2015; 10:e0122034. [PMID: 25807115 PMCID: PMC4373729 DOI: 10.1371/journal.pone.0122034] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 02/05/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Between 19%-44% pregnant women are prescribed antibiotics during pregnancy. A single, large randomised-controlled-trial (ORACLE Childhood Study II) found an increased risk of childhood cerebral palsy and possibly epilepsy following prophylactic antibiotic use in pregnant women with spontaneous preterm labour. We ascertained whether this outcome could be reproduced across the population of babies delivered at term and prospectively followed in primary-care using data from The Health Improvement Network. METHODS We determined the risk of cerebral palsy or epilepsy in children whose mothers were prescribed antibiotics during pregnancy using a cohort of 195,909 women linked to their live, term-born, singleton children. We compared the effect of antibiotic class, number of courses and timing of prescribing in pregnancy. Analyses were adjusted for maternal risk factors (e.g. recorded infection, age, chronic conditions, social deprivation, smoking status). Children were followed until age seven years or cessation of registration with the primary-care practitioner. RESULTS In total, 64,623 (33.0%) women were prescribed antibiotics in pregnancy and 1,170 (0.60%) children had records indicating cerebral palsy or epilepsy. Adjusted analyses showed no association between prescribing of any antibiotic and cerebral palsy or epilepsy (adj.HR 1.04, 95%CI 0.91-1.19). However, compared with penicillins, macrolides were associated with an increased risk of cerebral palsy or epilepsy (adj.HR 1.78, 95%CI 1.18-2.69; number needed to harm 153, 95%CI 71-671). CONCLUSIONS We found no overall association between antibiotic prescribing in pregnancy and cerebral palsy and/or epilepsy in childhood. However, our finding of an increased risk of cerebral palsy or epilepsy associated with macrolide prescribing in pregnancy adds to evidence that macrolide use is associated with serious harm.
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Affiliation(s)
- Wilhelmine Hadler Meeraus
- UCL Institute of Child Health, Population Policy and Practice Programme, London, United Kingdom
- UCL Research Department of Primary Care and Population Health, London, United Kingdom
| | - Irene Petersen
- UCL Research Department of Primary Care and Population Health, London, United Kingdom
| | - Ruth Gilbert
- UCL Institute of Child Health, Population Policy and Practice Programme, London, United Kingdom
- Farr Institute of Health Informatics Research, London, United Kingdom
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Santos J, Aguilar L, García-Méndez E, Siquier B, Custardoy J, García-Rey C, Pallarés R, Blanquer R, Caminero J, Dal-Ré R, Durán J, Gil-Aguado A, Grau I, Ibáñez D, Llorca E, Martínez J, Molinos L, Mensa J, Moreno S, Palacios R, Vidal J. Clinical Characteristics and Response to Newer Quinolones inLegionellaPneumonia: A Report of 28 Cases. J Chemother 2013; 15:461-5. [PMID: 14598938 DOI: 10.1179/joc.2003.15.5.461] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Twenty-eight (11.6%) out of 241 Spanish patients enrolled in an international phase III clinical trial of mild to moderate community-acquired pneumonia (CAP) comparing gemifloxacin vs. trovafloxacin were diagnosed of Legionnaires' disease. A definite diagnosis was established by seroconversion in 13 patients of whom only 2 had a positive Legionella urinary antigen. The remaining 15 patients were possible Legionella infections based on a single elevated IgG titer (> or = 1:512). All patients had a radiologically confirmed diagnosis of pneumonia, 5 (19%) patients were older than 65, comorbidity was present in 9 (33%), and 10 (36%) had to be hospitalized. Fifteen patients were treated with oral gemifloxacin (320 mg/day) and 13 with oral trovafloxacin (200 mg/day). Overall, clinical success occurred in 25 (89.3%) patients after 7 days of treatment and only 1 patient needed a 14-day treatment. There were only one adverse event withdrawal and one clinical failure, and no patients died. In light of the favorable clinical outcome, the use of newer fluoroquinolones seems adequate for the treatment of suspected or proven Legionella pneumonia.
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Affiliation(s)
- J Santos
- Infectious Diseases Unit, Hospital Virgen de la Victoria, Málaga, Spain
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12
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Poritz MA, Blaschke AJ, Byington CL, Allen L, Nilsson K, Jones DE, Thatcher SA, Robbins T, Lingenfelter B, Amiott E, Herbener A, Daly J, Dobrowolski SF, Teng DHF, Ririe KM. FilmArray, an automated nested multiplex PCR system for multi-pathogen detection: development and application to respiratory tract infection. PLoS One 2011; 6:e26047. [PMID: 22039434 PMCID: PMC3198457 DOI: 10.1371/journal.pone.0026047] [Citation(s) in RCA: 262] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 09/16/2011] [Indexed: 12/19/2022] Open
Abstract
The ideal clinical diagnostic system should deliver rapid, sensitive, specific and reproducible results while minimizing the requirements for specialized laboratory facilities and skilled technicians. We describe an integrated diagnostic platform, the "FilmArray", which fully automates the detection and identification of multiple organisms from a single sample in about one hour. An unprocessed biologic/clinical sample is subjected to nucleic acid purification, reverse transcription, a high-order nested multiplex polymerase chain reaction and amplicon melt curve analysis. Biochemical reactions are enclosed in a disposable pouch, minimizing the PCR contamination risk. FilmArray has the potential to detect greater than 100 different nucleic acid targets at one time. These features make the system well-suited for molecular detection of infectious agents. Validation of the FilmArray technology was achieved through development of a panel of assays capable of identifying 21 common viral and bacterial respiratory pathogens. Initial testing of the system using both cultured organisms and clinical nasal aspirates obtained from children demonstrated an analytical and clinical sensitivity and specificity comparable to existing diagnostic platforms. We demonstrate that automated identification of pathogens from their corresponding target amplicon(s) can be accomplished by analysis of the DNA melting curve of the amplicon.
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Affiliation(s)
- Mark A Poritz
- Idaho Technology, Inc., Salt Lake City, Utah, United States of America.
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Jartti L, Langen H, Söderlund-Venermo M, Vuorinen T, Ruuskanen O, Jartti T. New respiratory viruses and the elderly. Open Respir Med J 2011; 5:61-9. [PMID: 21760867 PMCID: PMC3134957 DOI: 10.2174/1874306401105010061] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 04/04/2011] [Accepted: 05/17/2011] [Indexed: 12/21/2022] Open
Abstract
The diagnostics of respiratory viral infections has improved markedly during the last 15 years with the development of PCR techniques. Since 1997, several new respiratory viruses and their subgroups have been discovered: influenza A viruses H5N1 and H1N1, human metapneumovirus, coronaviruses SARS, NL63 and HKU1, human bocavirus, human rhinoviruses C and D and potential respiratory pathogens, the KI and WU polyomaviruses and the torque teno virus. The detection of previously known viruses has also improved. Currently, a viral cause of respiratory illness is almost exclusively identifiable in children, but in the elderly, the detection rates of a viral etiology are below 40%, and this holds also true for exacerbations of chronic respiratory illnesses. The new viruses cause respiratory symptoms like the common cold, cough, bronchitis, bronchiolitis, exacerbations of asthma and chronic obstructive pulmonary disease and pneumonia. Acute respiratory failure may occur. These viruses are distributed throughout the globe and affect people of all ages. Data regarding these viruses and the elderly are scarce. This review introduces these new viruses and reviews their clinical significance, especially with regard to the elderly population.
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Affiliation(s)
- Laura Jartti
- Department of Geriatrics, Turku City Hospital, Turku, Finland
| | | | | | - Tytti Vuorinen
- Department of Virology, University of Turku, Turku, Finland
| | - Olli Ruuskanen
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Tuomas Jartti
- Department of Pediatrics, Turku University Hospital, Turku, Finland
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Abstract
Mycoplasma pneumoniae is a common cause of upper and lower respiratory tract infections. Pneumonia is the most clinically important manifestation, but tracheobronchitis and various nonspecific upper respiratory tract symptoms are more typically seen in clinical settings. M. pneumoniae can cause pharyngitis with or without concomitant lower respiratory tract involvement, but it is less commonly detected in other upper respiratory conditions such as otitis media, sinusitis, and the common cold. A variety of methods exist for laboratory diagnosis of M. pneumoniae infection, including culture, serology, and the polymerase chain reaction assay, but each has limitations. This article provides a summary of recent studies that have evaluated the role of M. pneumoniae in upper respiratory tract infections; a brief discussion of its cell biology, pathogenic mechanisms, and epidemiology; and recommendations for laboratory diagnosis and management.
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Loens K, Goossens H, Ieven M. Acute respiratory infection due to Mycoplasma pneumoniae: current status of diagnostic methods. Eur J Clin Microbiol Infect Dis 2010; 29:1055-69. [PMID: 20526788 PMCID: PMC7088226 DOI: 10.1007/s10096-010-0975-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 05/18/2010] [Indexed: 11/30/2022]
Abstract
Because of the absence of well-standardized both in-house and FDA-approved commercially available diagnostic tests, the reliable diagnosis of respiratory infection due to Mycoplasma pneumoniae remains difficult. In addition, no formal external quality assessment schemes which would allow to conclude about the performance of M. pneumoniae diagnostic tests exist. In this review, the current state of knowledge of M. pneumoniae-associated respiratory infections in the context of epidemiological studies published during the past 5 years is discussed, with particular emphasis on the diagnostic strategies used and their impact on results. The role of M. pneumoniae as a cause of respiratory tract infections (RTIs) differs from study to study due to geographical and epidemiological differences, as well as to the application of different diagnostic techniques and criteria used.
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Affiliation(s)
- K Loens
- Department of Microbiology, Vaccine and Infectious Disease Institute (VIDI), University of Antwerp, Antwerp, Belgium.
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16
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Limited value of chest radiography in predicting aetiology of lower respiratory tract infection in general practice. Br J Gen Pract 2008; 58:93-7. [PMID: 18307852 DOI: 10.3399/bjgp08x264054] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND In patients with lower respiratory tract infection (LRTI), changes on chest radiography are rare but poorly characterised, especially in general practice. AIM To describe the range of findings on chest radiographs and the associations between these findings and the aetiology of LRTI. DESIGN OF STUDY A prospective observational study. SETTING General practices in the Leiden region, The Netherlands. METHOD Adult patients with a defined LRTI were included. Standard medical history and physical examination were performed. Sputum, blood, and throat swabs were collected for diagnostic tests. Chest X-ray findings were assessed in relation to the aetiology. RESULTS An abnormality on the chest X-ray was observed in 72 (55%) patients. Forty-five patients (35%) had changes due to infection, and 26 (20%) due to pneumonia. Pathogens were detected in 84 patients (33 single bacterial, 43 single viral, and 8 dual). Twelve (29%) patients with a bacterial infection (including dual infections) compared to four (9%) patients with viral infection had pneumonia on the chest X-ray (odds ratio [OR] = 4.0; 95% confidence interval [CI] = 1.2 to 13.8). Using the presence of pneumonia on chest X-ray as a test to predict a bacterial infection, the positive predictive value and the negative predictive value were 75% (CI = 48 to 93%) and 57% (CI = 45 to 69%), respectively. CONCLUSION Pneumonia on the chest X-ray was found more frequently in patients with a bacterial infection than in patients with a viral infection. However, the sensitivity and the specificity are such that pneumonia on the chest X-ray is not a reliable test to discriminate between bacterial and non-bacterial LRTI in the general practice setting.
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17
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Holm A, Nexoe J, Bistrup LA, Pedersen SS, Obel N, Nielsen LP, Pedersen C. Aetiology and prediction of pneumonia in lower respiratory tract infection in primary care. Br J Gen Pract 2007; 57:547-54. [PMID: 17727747 PMCID: PMC2099637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Knowledge of predominant pathogens and their association with outcome are of importance for the management of lower respiratory tract infection (LRTI). As antibiotic therapy is indicated in pneumonia and not in acute bronchitis, a predictor of pneumonia is needed. AIM To describe the aetiology and outcome of LRTI in adults with pneumonic and adults with non-pneumonic LRTI treated in general practice and to identify predictors of radiographic pneumonia. DESIGN OF STUDY Prospective, observational study. SETTING Forty-two general practices and an outpatient clinic at the Department of Infectious Diseases, Odense University Hospital, Denmark. METHOD A total of 364 adults diagnosed with community-acquired LRTI by their GP were studied with chest radiography, vital signs, biochemical markers of inflammation (C-reactive protein [CRP] and leukocyte count), and microbiological examinations. Primary outcome measure was hospitalisation within 4 weeks. RESULTS Pneumonia was radiographically verified in 48 of 364 patients (13%). Bacterial infection was seen more often in patients with pneumonia (33% versus 17%, P<0.001), and viral infection more often in non-pneumonic patients (26% versus 13%, P<0.05). Hospitalisation was more common in patients with pneumonia compared to non-pneumonic patients (19 versus 3%, P<0.001); and in patients with pneumococcal infection compared with patients without pneumococcal infection (26 versus 4%, P = 0.001). The positive predictive value of GPs' diagnosis of pneumonia was low (0.23), but the vital signs, CRP, and leukocyte count had comparably low positive predictive values (0.23-0.30). CONCLUSION Streptococcus pneumoniae was the most common bacterial pathogen. The risk of hospitalisation was highest among patients with pneumonia or pneumococcal infection; this emphasises the importance of coverage of S. pneumoniae when treatment is indicated. CRP should not be introduced for diagnosis of radiographic pneumonia in general practice before its use has been investigated in prospective, controlled intervention trials using CRP-guided treatment algorithms.
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Affiliation(s)
- Anette Holm
- Department of Infectious Diseases C, Odense University Hospital, Denmark.
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18
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Philippart F. [Managing lower respiratory tract infections in immunocompetent patients. Definitions, epidemiology, and diagnostic features]. Med Mal Infect 2006; 36:784-802. [PMID: 17092676 PMCID: PMC7131155 DOI: 10.1016/j.medmal.2006.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Accepted: 07/21/2006] [Indexed: 11/13/2022]
Abstract
Les infections respiratoires basses sont une des principales cause de mortalité dans le monde et les pneumopathies représentent en France la première cause de décès d'origine infectieuse. Trois entités nosologiques distinctes sont habituellement isolées en fonction de la localisation infectieuse : la bronchite aiguë, la pneumopathie et la bronchopneumopathie (atteignant les bronches et le parenchyme pulmonaire). En cas d'infections de l'arbre bronchique dans le cadre d'une bronchopathie chronique on parle de décompensation infectieuse de la maladie bronchique. Les deux principales difficultés diagnostiques de ces infections sont de déterminer la présence d'une participation alvéolaire au processus infectieux et de définir l'agent (ou les agents) pathogènes. Ces deux éléments vont conditionner la prise en charge thérapeutique. En dehors de l'examen physique, indispensable dans ce contexte, seule la radiographie thoracique pourra, en cas de persistance d'un doute, permettre de confirmer la présence d'une participation alvéolaire. Le diagnostic microbiologique pose la question de sa nécessité systématique et celui de sa valeur. Il n'est pas indispensable de réaliser un diagnostic microbiologique de certitude dans tous les cas. La décision de documentation doit répondre à deux impératifs : faisabilité et valeur diagnostique. La valeur d'un prélèvement dépend de son aptitude à mettre en évidence l'agent pathogène et dans certains cas de la possibilité d'en déterminer le profil de sensibilité (qui reste une indication majeure à la réalisation de ces prélèvements).
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Affiliation(s)
- F Philippart
- Service de réanimation polyvalente, fondation-hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
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19
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Agulló-Ortuño MT, García-Mancebo ML, Montes-Ares O, Noguera-Velasco JA. Biochemical and immunologic features of an outbreak of Legionnaires disease: comparative study between community-acquired pneumonias. Diagn Microbiol Infect Dis 2006; 56:7-11. [PMID: 16650955 DOI: 10.1016/j.diagmicrobio.2006.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Revised: 02/12/2006] [Accepted: 02/13/2006] [Indexed: 11/24/2022]
Abstract
Legionella pneumophila has been recognized as an important cause of community- and hospital-acquired pneumonia. This study evaluates the interrelationship between that patients group with Legionnaires disease (LD) and the possible factors that may predispose hosts to acquire this infection. Likewise, we search for preliminary biochemical and immunologic evidences that could help physicians to differentiate between LD and other pneumonias. We analyzed biochemical parameters and immunoglobulin levels in 61 LD patients and a control group (n = 30) who were non-Legionella pneumonia diagnosed. We observed statistically significant differences in LD patients versus control group in serum sodium, albumin, gamma-band, IgG levels, (P < .01) and for total proteins, aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) (P < .05). Our study shows a trend between the presence of LD and immunoglobulin deficiencies in the group studied. Deficit in IgG or IgG plus IgM, during the exposure period, may predispose individuals to suffer legionellosis (P < .05). Overall, hypoalbuminemia, hyponatremia, and high AST and LDH levels can represent a useful prognostic marker in patients with severe pulmonary infection suspected to be legionellosis.
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Affiliation(s)
- Ma Teresa Agulló-Ortuño
- Servicio de Análisis Clínicos, Hospital Universitario Virgen de la ARRIXACA, Ctra. Madrid-Cartagena S/N, 30120 El Palmar, Murcia, Spain.
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20
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Friedman MG, Kahane S, Dvoskin B, Hartley JW. Detection of Simkania negevensis by culture, PCR, and serology in respiratory tract infection in Cornwall, UK. J Clin Pathol 2006; 59:331-3. [PMID: 16505289 PMCID: PMC1860349 DOI: 10.1136/jcp.2004.025601] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Respiratory tract infections are often treated empirically without investigation to detect the aetiological agent, which may be a virus or a bacterium, including atypical pathogens such as Chlamydophila pneumoniae or Mycoplasma pneumoniae. Recently, several types Chlamydia-like intracellular bacteria have been detected in environmental samples and clinical specimens. Little is known of their geographical distribution and potential pathogenicity. We describe the detection, by PCR and isolation in cell culture, of Simkania negevensis in nasopharyngeal aspirates of paediatric patients with bronchiolitis in Cornwall, UK. We also present serological evidence of exposure to the organism in 62% of adult patients and 46% of a sample of pregnant women. Empirical treatment of serious respiratory tract infection should consider the possible contribution of these organisms.
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Affiliation(s)
- M G Friedman
- Department of Virology, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
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21
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Webley WC, Salva PS, Andrzejewski C, Cirino F, West CA, Tilahun Y, Stuart ES. The bronchial lavage of pediatric patients with asthma contains infectious Chlamydia. Am J Respir Crit Care Med 2005; 171:1083-8. [PMID: 15735056 DOI: 10.1164/rccm.200407-917oc] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There has been a worldwide increase in the incidence of asthma, and the disease has greatly impacted the public health care system. Chlamydia pneumoniae has been reported as a possible contributing factor in asthma. The organism has been detected by polymerase chain reaction (PCR) in bronchial tissue, but there has been no direct evidence of viability. To determine the frequency of viable Chlamydia in children, blood and bronchoalveolar lavage were collected from 70 pediatric patients undergoing flexible fiberoptic bronchoscopy. Forty-two of these patients had asthma, whereas the remaining patients had various respiratory disorders. Fifty-four percent (38) of the bronchoalveolar lavage samples were PCR-positive for Chlamydia, and 31% (22) of the PCR-positive samples were positive when cultured on macrophages. Twenty-eight samples (40%) and 14 samples (20%) of the PCR- and culture-positive samples, respectively, were from patients with asthma. Culture of the blood samples revealed that 24 (34.3%) of 70 were positive for Chlamydia compared with 8 (11%) of 70 matched nonrespiratory control subjects (p < 0.01); 17 (24%) of the positive blood cultures from the respiratory group were from patients with asthma. Elevation of total IgE was strongly associated with lavage culture positivity for Chlamydia. We therefore conclude that viable Chlamydia pneumoniae organisms are frequently present in the lung lavage fluid from this cohort of predominantly asthmatic pediatric patients.
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Affiliation(s)
- Wilmore C Webley
- Department of Microbiology, University of Massachusetts, 639 North Pleasant Street, Amherst, MA 01003, USA.
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22
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Khan K, Muennig P, Gardam M, Zivin JG. Managing febrile respiratory illnesses during a hypothetical SARS outbreak. Emerg Infect Dis 2005; 11:191-200. [PMID: 15752435 PMCID: PMC3320437 DOI: 10.3201/eid1102.040524] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Since the World Health Organization declared the global outbreak of severe acute respiratory syndrome (SARS) contained in July 2003, new cases have periodically reemerged in Asia. This situation has placed hospitals and health officials worldwide on heightened alert. In a future outbreak, rapidly and accurately distinguishing SARS from other common febrile respiratory illnesses (FRIs) could be difficult. We constructed a decision-analysis model to identify the most efficient strategies for managing undifferentiated FRIs within a hypothetical SARS outbreak in New York City during the season of respiratory infections. If establishing reliable epidemiologic links were not possible, societal costs would exceed 2.0 billion US dollars per month. SARS testing with existing polymerase chain reaction assays would have harmful public health and economic consequences if SARS made up <0.1% of circulating FRIs. Increasing influenza vaccination rates among the general population before the onset of respiratory season would save both money and lives.
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Affiliation(s)
- Kamran Khan
- Inner City Health Research Unit, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, Canada M5B 1W8.
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23
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Abstract
Respiratory infections are common at all ages but are particularly sinister among the elderly because of the fragility and chronic comorbidity associated with this age group. The three types of respiratory infection in the elderly are community-acquired pneumonia, acute exacerbation of chronic obstructive pulmonary disease and nonpneumonic respiratory tract infection. The etiology of these three types of infection includes classic bacteria, atypical pathogens and respiratory viruses. The relative frequency of each of the etiological groups as the causative agent of the infection varies significantly among these types of infection, but in all three types a significant proportion of infections involves more than one pathogen. The causative agent of respiratory infection in the elderly cannot be determined on the basis of clinical manifestation or the results of routine imaging procedures or laboratory tests. Thus, initial antibiotic therapy in these patients should be empiric, based on accepted guidelines. In recent years, the antipneumococcal fluoroquinolones have gained in stature as one of the best options to treat these infections. Pneumococcal and influenza vaccinations can reduce morbidity and mortality from respiratory infections in the elderly, so it is important that all elderly individuals are vaccinated through a structured program in the framework of primary care. The economic impact of respiratory infections in the elderly is primarily associated with the requirement for hospitalization in many of the cases. Any action that can reduce hospitalization rates has important economic ramifications. In light of the difficulty in reaching an early etiologic diagnosis in respiratory infections, it is essential to invest in the development of a compact diagnostic kit for the early stages of the disease, which could change reality in this important area of medicine.
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Affiliation(s)
- David Lieberman
- Department of Geriatric Medicine, The Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Korppi M, Heiskanen-Kosma T, Kleemola M. Incidence of community-acquired pneumonia in children caused by Mycoplasma pneumoniae: Serological results of a prospective, population-based study in primary health care. Respirology 2004; 9:109-14. [PMID: 14982611 DOI: 10.1111/j.1440-1843.2003.00522.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of the present study was to assess the incidence of community-acquired pneumonia (CAP) in children caused by Mycoplasma pneumoniae. METHODOLOGY During 12 months in 1981-1982, all CAP cases in a defined child population were registered. M. pneumoniae aetiology, initially measured by complement fixation (CF) test, was in 1999 supplemented by measurement of IgG and IgM antibodies using enzyme immunoassays (EIA). RESULTS M. pneumoniae was detected in 61 (30%) of 201 paediatric CAP cases, being the most common aetiological agent in those 5 years of age or over. At that age, M. pneumoniae was responsible for over 50% of cases, and over 90% of mycoplasmal cases were treated as outpatients. The EIA detected 17 new cases over and above the 44 detected by CF, while CF alone revealed 10 cases. The incidence of M. pneumoniae CAP increased with age, being over 10/1000 children at the age of 10 years or more. Co-infections with Streptococcus pneumoniae and Chlamydia pneumoniae were present in over 30% and 15%, respectively, of mycoplasmal CAP cases. CONCLUSION M. pneumoniae is a common cause of paediatric CAP in primary health care, and co-infections with S. pneumoniae are common. Both S. pneumoniae and M. pneumoniae should be taken into account when starting antibiotics for children with CAP.
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Affiliation(s)
- Matti Korppi
- Department of Pediatrics, Kuopio University and University Hospital, Kuopio, Finland.
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25
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Graffelman AW, Knuistingh Neven A, le Cessie S, Kroes ACM, Springer MP, van den Broek PJ. A diagnostic rule for the aetiology of lower respiratory tract infections as guidance for antimicrobial treatment. Br J Gen Pract 2004; 54:20-4. [PMID: 14965402 PMCID: PMC1314773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND The majority of patients with lower respiratory tract infections (LRTIs) are treated with antibiotics; some of them are unnecessary because of a viral cause. Information on prediction of the aetiology, especially in a general practice setting, is missing. AIM To differentiate between viral and bacterial LRTI on simple clinical criteria, easily obtained at the bedside. DESIGN OF STUDY Prospective observational study. SETTING General practices in the Leiden region of The Netherlands. METHOD Adult patients with LRTI were included. Standard medical history and physical examination were performed. Sputum, blood and throat swabs were collected for diagnostic tests. According to microbiological findings, patients were classified as bacterial, viral, dual infection and unknown cause. In a logistic regression model independent predictors were determined. Scoring systems were developed. The accuracies of the diagnostic rules were tested by using receiver operating characteristic (ROC) curves. RESULTS One-hundred and forty-five patients were classified as having bacterial (n = 35), viral (n = 49), or dual infection (n = 8), or infection of unknown cause (n = 53), respectively. Independent predictors for bacterial infection were fever (odds ratio [OR] = 8.0; 95% confidence interval [CI] = 0.9 to 71.0), headache (OR = 4.3; 95% CI = 1.0 to 19.1) cervical painful lymph nodes (OR = 8.7; 95% CI = 1.1 to 68.0), diarrhoea (OR = 0.3; 95% CI = 0.1 to 1.0) and rhinitis (OR = 0.3; 95% CI = 0.1 to 0.9). As an additional independent predictor, an infiltrate on chest X-ray (OR = 5.0; 95% CI = 1.2 to 20.5) was found. The diagnostic rules developed from these variables classified the aetiology of LRTI with a ROC curve area of 0.79 (clinical score), 0.77 (simplified score) and 0.83 (extended score). CONCLUSIONS A diagnostic rule was developed, based on information that is easy to obtain at the bedside, to predict a bacterial infection. This diagnostic rule may be a tool for general practitioners in their management of patients with LRTI.
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Affiliation(s)
- A Willy Graffelman
- Department of General Practice and Nursing Home Medicine, Leiden University Medical Center, Leiden, The Netherlands.
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26
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Templeton KE, Scheltinga SA, Graffelman AW, Van Schie JM, Crielaard JW, Sillekens P, Van Den Broek PJ, Goossens H, Beersma MFC, Claas ECJ. Comparison and evaluation of real-time PCR, real-time nucleic acid sequence-based amplification, conventional PCR, and serology for diagnosis of Mycoplasma pneumoniae. J Clin Microbiol 2003; 41:4366-71. [PMID: 12958270 PMCID: PMC193789 DOI: 10.1128/jcm.41.9.4366-4371.2003] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Mycoplasma pneumoniae is a common cause of community-acquired pneumonia and lower-respiratory-tract infections. Diagnosis has traditionally been obtained by serological diagnosis, but increasingly, molecular techniques have been applied. However, the number of studies actually comparing these assays is limited. The development of a novel duplex real-time PCR assay for detection of M. pneumoniae in the presence of an internal control real-time PCR is described. In addition, real-time nucleic acid sequence-based amplification (NASBA) on an iCycler apparatus is evaluated. These assays were compared to serology and a conventional PCR assay for 106 clinical samples from patients with lower-respiratory-tract infection. Of the 106 samples, 12 (11.3%) were positive by all the molecular methods whereas serology with acute sample and convalescent samples detected 6 (5.6%) and 9 (8.5%), respectively. Clinical symptoms of the patients with Mycoplasma-positive results were compared to those of the other patients with lower-respiratory-tract infections, and it was found that the results for mean lower age numbers as well as the presence of chills, increased erythrocyte sedimentation rate, and raised C-reactive protein levels showed significant differences. Molecular methods are superior for diagnosis of M. pneumoniae, providing more timely diagnosis. In addition, using real-time methods involves less hands-on time and affords the ability to monitor the reaction in the same tube.
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Affiliation(s)
- Kate E Templeton
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
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Johnson DM, Sader HS, Fritsche TR, Biedenbach DJ, Jones RN. Susceptibility trends of haemophilus influenzae and Moraxella catarrhalis against orally administered antimicrobial agents: five-year report from the SENTRY Antimicrobial Surveillance Program. Diagn Microbiol Infect Dis 2003; 47:373-6. [PMID: 12967753 DOI: 10.1016/s0732-8893(03)00089-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The assessment of orally administered antimicrobial susceptibilities of common pathogens that cause community-acquired respiratory tract infections (CARTI) has become exceedingly important due to the number of office visits for this indication. Numerous local, regional and global studies have documented the susceptibilities of Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis, the most common CARTI pathogens. SENTRY Antimicrobial Surveillance Program sites in North and Latin America, and Europe were requested to send a combined total of 100 isolates of these pathogens to the local monitor for reference broth microdilution testing (1997-2001). This study compared the susceptibility profiles of H. influenzae and M. catarrhalis isolates (13,370 strains) from the three geographic regions over a five year period. beta-lactamase mediated ampicillin resistance among H. influenzae was highest among North American isolates (27.9%) compared to Latin America and Europe (16.2 to 16.3%), although it was noted that during the five year study period, ampicillin resistance was steadily increasing in the latter two regions. Cefprozil (84.3% susceptible) and clarithromycin (81.1% susceptible) were also less active against North American H. influenzae isolates. Latin American isolates were much less susceptible to trimethoprim/sulfamethoxazole (T/S; 59.3%) compared to the other regions (75.8 to 78.6%). M. catarrhalis isolates were also significantly less susceptible to T/S in Latin America (10.5% resistance). The production of beta-lactamase enzymes among the M. catarrhalis isolates exceeded >95% in all three regions during the five year period. The fluoroquinolones (FQ) remained very active against these two respiratory pathogens with rare isolates with elevated FQ MIC results. It is apparent from this investigation that many commonly prescribed empiric treatments remain viable therapeutic options for CARTI caused by these two Gram-negative respiratory tract pathogens.
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Affiliation(s)
- D M Johnson
- The JONES Group/JMI Laboratories, North Liberty, IA, USA
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Abstract
Mortality of pneumonia is low in the outside setting (1%) but rises up to 20% in hospital admitted patients. Early diagnosis and standardized therapy improve patient's prognosis. For community acquired pneumonia age, comorbidity and the setting of therapy (outside department, normal ward or intensive care unit) are the most important variables to choose an adequate antibiotic treatment. For nosocomial pneumonia risk stratification is according to severity of illness, length of hospital stay and antibiotic pretreatment. In the outpatient setting a 7-day monotherapy is mostly successful. In severe illness the combination of a betalactam antibiotic with a new fluorchinolon seems to be superior to an aminoglycosid therapy. Antibiotic resistance due to mistakes in antibiotic therapy is an increasing problem in the intensive care unit. Therefore, pneumonia preventive measures like influenza and pneumococcal vaccination become more important. Standardized hygienical procedures help to reduce nosocomial, mainly ventilator associated pneumonia.
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Affiliation(s)
- T Welte
- Bereich Pneumologie und internistische Intensivmedizin, Otto-von-Guericke-Universität Magdeburg.
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Lieberman D, Lieberman D, Printz S, Ben-Yaakov M, Lazarovich Z, Ohana B, Friedman MG, Dvoskin B, Leinonen M, Boldur I. Atypical pathogen infection in adults with acute exacerbation of bronchial asthma. Am J Respir Crit Care Med 2003; 167:406-10. [PMID: 12426232 DOI: 10.1164/rccm.200209-996oc] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In a serologically based prospective study, acute infections with four atypical pathogens were determined in 100 adults hospitalized for acute exacerbation of bronchial asthma, and compared with the corresponding rate in a matched control group. Paired sera were tested using immunofluorescence or enzyme immunoassay methods to establish the serologic diagnosis. In 18 patients (18%), there was evidence of acute infection with Mycoplasma pneumoniae, compared with 3% in the control group (p = 0.0006). In 10 of these patients there was evidence of infection with at least one additional pathogen, a respiratory virus in 7. There was no significant difference between the study groups in the rates of acute infection by Chlamydia pneumoniae (8% in the hospitalized patients versus 6% in the control subjects), Legionella spp. (5 versus 3%, respectively), or Coxiella burnettii (no patients in either group). We conclude that of these four atypical pathogens, only infection with M. pneumoniae is associated with hospitalization for acute exacerbation of bronchial asthma. In most of these M. pneumoniae patients there is evidence of infection with a respiratory virus as well. The pathophysiologic and therapeutic significance of these findings should be tested in further studies specifically designed to address these questions.
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Affiliation(s)
- David Lieberman
- Pulmonary Unit and Division of Internal Medicine, Soroka Medical Center, and the Department of Virology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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