Kawasaki disease andChlamydia pneumoniae infection

Chlamydia pneumoniae infections have been associated with coronary artery disease. Although Kawasaki disease is characterized by an association with coronary artery disease in children predominantly under the age of 5, the etiology is still unknown. Serum samples were obtained from 72 infants and children, aged 5 months to 7 years, in the active febrile phase of Kawasaki disease and tested for the presence ofC. pneumoniae serum antibodies. Twenty-seven (37.5%) serum samples were positive for an IgG antibody, 22 (30.6%) were positive for an IgA antibody, and 11 (15.3%) were positive for an IgM antibody toC. pneumoniae. The presence of serum IgM antibodies toC. pneumoniae in infants and children in the acute phase of Kawasaki disease was significantly higher than that of age-matched healthy controls (P<0.01).     

Evaluation of the diagnostic usefulness of real-time PCR for detection of Chlamydophila pneumoniae in acute respiratory infections

We investigated whether a real-time polymerase chain reaction (PCR) test is a useful diagnostic tool for identifying individuals with acute respiratory Chlamydophila pneumoniae infections. Nasopharyngeal swab specimens and peripheral blood mononuclear cells (PBMCs) from 100 patients with acute respiratory tract infections and 140 asymptomatic healthy subjects (controls) were analyzed using real-time PCR, culture, and serology for the detection of C. pneumoniae. Six patients had serological results indicating acute C. pneumoniae infections. C. pneumoniae DNA was detected in respiratory samples from eight patients (three of these cases were serologically confirmed as having C. pneumoniae infections) and four controls. The amount of C. pneumoniae DNA present in the real-time PCR for the samples was calculated, and no significant differences in the amount of DNA between symptomatic and asymptomatic subjects were found. On the other hand, traces of C. pneumoniae DNA were detected in PBMCs from eight patients, but this was confirmed in PBMCs from only seven of these patients. Only one patient had both respiratory and blood samples that were positive. C. pneumoniae DNA was also detected in samples from six controls, but no significant differences in the amount of C. pneumoniae DNA were observed between patients and controls. The present quantitative real-time PCR assay does not seem to be a useful method for differentiating between C. pneumoniae acute infections and persistent ones or nasopharyngeal carriage. In addition, the detection of C. pneumoniae DNA in PBMCs does not seem to be a suitable method for the diagnosis of acute respiratory C. pneumoniae infections.     

Prevalence of Chlamydophila pneumoniae among Bangladeshi children under age 5 years with acute respiratory infections

Despite major improvements in the diagnosis of pathogenic organisms causing acute respiratory infections (ARIs), details of infections caused by atypical pathogens are not well understood, particularly in developing countries. This clinical and epidemiological research was conducted in Bangladesh to explore the prevalence of atypical pathogens in causing childhood pneumonia. Sixty-four children with ARI were studied at the Pediatric Outpatient Department of Dhaka Medical College Hospital, Bangladesh, during September through December 2000. In addition to clinical examination, hematological, radiological, and bacteriological examinations were performed. Antibody titers from paired sera against Mycoplasma pneumoniae and Legionella spp. in the acute and convalescent phases revealed that none of these children were infected with M. pneumoniae, while only one serum sample was positive for L. pneumophila serogroup 4. Antibody titers against Chlamydophila (Chlamydia) pneumoniae, determined by an indirect microimmunofluorescence method, and by an enzyme-linked immunosorbent assay (ELISA) kit (HITAZYME C. pneumoniae kit) indicated that 13 children (20.3%) were infected with C. pneumoniae. Our results indicate a high prevalence rate of C. pneumoniae, suggesting it is as an important causative pathogen of childhood pneumonia in Bangladesh.     

Association between Chlamydia pneumoniae IgG antibodies and migraine

In this study, there is a confirmed association between cerebral infarction with migraine and Chlamydia pneumoniae infection, but the association between C. pneumoniae IgG antibodies and migraine in the general population has not been investigated. C. pneumoniae IgG antibody levels were compared in 329 adult Chinese patients, who met the International Classification of Headache Disorders 2nd Edition (ICHD II) criteria for migraine, and in 329 healthy subjects. Factors such as gender, age, smoking, consumption of pickle, and body mass index were evaluated. One hundred and ninety-five (59.2%) migraine sufferers and 70 (21.27%) controls were C. pneumoniae IgG antibody-seropositive (P < 0.05). Based on a multivariate stepwise logistic model, the odds’ ratios for C. pneumoniae IgG antibody seropositivity, body mass index, smoking, and consumption of pickle were 3.397 (P = 0.000), 0.858 (P = 0.014), 1.692 (P = 0.012), and 5.469 (P = 0.0000), respectively. In conclusion, C. pneumoniae IgG antibodies may be a risk factor for migraine.     

Organisms detected in the uterine adnexa in patients with adnexal infections at different stages of the inflammatory process

This study investigated organisms causing uterine adnexal infections by examining specimens from the adnexa obtained by laparoscopy or laparotomy. Forty-nine organisms were detected from 45 patients with adnexal infections. Of these patients, a subgroup of 35 had no recent delivery or invasive procedure, and consisted of 16 with acute salpingitis (stage A), 9 with pyosalpinx or inflammatory complex (stage B), and 10 with tuboovarian abscess (stage C). The percentage of stage A, B and C patients withChlamydia trachomatis was 81.3%, 33.3% and 20%, respectively (A vs. B,P=0.031; A vs. C,P=0.004, Fisher exact test). Among the 13 chlamydia-positive stage A patients, only 1 was polymicrobial, and all were chlamydia-positive in the cervix. The percentage of patients in stages A, B and C withNeisseria gonorrhoeae, was 0%, 33.3% and 0%, respectively (A vs. B,P=0.036, Fisher exact test). TheN. gonorrhoeae-positive patients were all polymicrobial, andN. gonorrhoeae was found in the cervix in 33.3% of the patients. These results suggest thatC. trachomatis is the most prevalent primary infective organism which gains easy unaided access to the upper genital tract from the cervix. The ascent ofN. gonorrhoeae may be predisposed or facilitated byC. trachomatis or overgrowth of other bacteria in the vaginal flora. As empiric therapy for adnexal infections, antimicrobials should have broad spectrum activity against organisms includingC. trachomatis, N. gonorrhoeae, and aerobes and anaerobes.     

In vitro and in vivo activities of sparfloxacin and reference drugs againstChlamydia pneumoniae

The activities of sparfloxacin and reference drugs againstChlamydia pneumoniae were compared by using in vitro and in vivo methods. The minimum inhibitory concentration (MIC) (μg/ml) ranges of sparfloxacin, levofloxacin, tosufloxacin, grepafloxacin, AM-1155, DU-6859a, clarithromycin, azithromycin, and minocycline for sixC. pneumoniae strains (two standard and four clinical strains) were 0.031 to 0.063, 0.25 to 0.5, 0.063 to 0.125, 0.063 to 0.125, 0.063 to 0.125, 0.031 to 0.063, 0.016 to 0.031, 0.125 to 0.25, and 0.016 to 0.031, respectively. The in vitro potency of sparfloxacin againstC. pneumoniae was similar to that of clarithromycin, minocycline, and DU-6859a, and higher than that of the other fluoroquinolones and azithromycin. Fatal pneumonia was induced in cyclophosphamide-treated leukopenic mice by intranasal inoculation withC. pneumoniae KKpn-2. Infiltration of the lung by neutrophils and lymphocytes was confirmed by histopathologic examination. Oral treatment with the various antichlamydial agents was given for seven days; sparfloxacin and minocycline had the lowest ED₅₀ (effective treatment dose in 50% of the mice; given as mg/kg per dose) (1.11 each), followed by DU-6859a (1.92), tosufloxacin (2.09), grepafloxacin (2.41), clarithromycin and azithromycin (2.48 each), AM-1155 (2.77), and levofloxacin (>10). These results suggest that sparfloxacin may be an effective agent forC. pneumoniae infection in humans.     

The association between serological features of chronic Chlamydia pneumoniae infection and markers of systemic inflammation and nutrition in COPD patients

Introduction: Chlamydia pneumoniae is an obligatory human pathogen involved in lower and upper airway infections, including pneumonia, bronchitis. Asymptomatic C. pneumoniae carriage is also relatively common. The association of C. pneumoniae infections with the chronic obstructive pulmonary disease (COPD) course is unclear.

Objectives: The aim of the study was to investigate the association between chronic C. pneumoniae infection and clinical features of COPD, markers of inflammation and metabolic dysfunction.

Patients and methods: The study included 59 patients with stable COPD who had no, or had?≥2 acute exacerbations during last year. The level of IgA and IgG antibody against C. pneumoniae, IL-6, IL-8, resistin, insulin, adiponectin and acyl ghrelin was measured in serum by enzyme-linked immunosorbent assay (ELISA).

Results: No differences in clinical and functional data were observed between COPD patients without serological features of C. pneumoniae infection and chronic C. pneumoniae infection. The level of anti C. pneumoniae IgA significantly correlated with IL-8, IL-6, resistin concentration in group of frequent exacerbators. IgG level correlated negatively with acetyl ghrelin and body mass index (BMI) in patients without frequent exacerbations, in contrast to frequent COPD exacerbation group where significant correlations between IgG level and BMI was demonstrated. Serum IL-6 correlated positively with resistin and insulin and negatively with adiponectin in group of patients with serological features of chronic C. pneumoniae infection only.

Conclusions: Our study showed that chronic C. pneumoniae infection does not influence the clinical course of COPD in the both study groups. Chronic C. pneumoniae infections might be associated with a distinct COPD phenotype that affects metabolic dysfunction.     

Evaluation of serological tests for diagnosis of Chlamydophila pneumoniae pneumonia in patients with nursing and healthcare-associated pneumonia

Nursing and healthcare-associated pneumonia (NHCAP) is a new category that is distinct from community-acquired pneumonia that has been documented in the 2011 Japanese Respiratory Society (JRS) guidelines. We aimed to evaluate an ELNAS Plate test for detecting anti-Chlamydophila pneumoniae-specific immunoglobulin M (IgM) antibodies in patients with NHCAP, by comparing the results of the ELNAS test with those of the Hitazyme enzyme-linked immunosorbent assay (Hitazyme-ELISA) and those of immunoblotting and microimmunofluorescence (MIF) tests. During the study period, we enrolled 739 patients with pneumonia in a university hospital and 812 patients with pneumonia in a community hospital; of these, 250 (34 %) and 349 (43 %), respectively, were classified as having NHCAP. C. pneumoniae pneumonia was detected in five cases by the MIF test and ELNAS test. All five cases demonstrated significant IgG antibody seroconversion, while one case was IgM-positive. Sixty-seven of the total of 599 patients (11 %) were C. pneumoniae IgM-positive on the Hitazyme-ELISA. One of the IgM-positive cases was confirmed by other methods and was shown to be a true positive. In the remaining cases, however, three other tests–the ELNAS test, the MIF test, and immunoblotting analysis–did not reveal any positive cases. The ELNAS, Hitazyme-ELISA, and MIF tests did not detect any significant increases in IgG or IgA antibody titers between paired sera. The results of the newly available ELNAS test for detecting anti-C. pneumoniae-specific IgM antibody correlated well with the results of the other established serological tests. To increase the diagnostic rate in patients with NHCAP, physicians should measure IgG antibody rather than IgM antibody using paired sera.     

Chlamydophila pneumoniae serology: cross-reaction with Mycoplasma pneumoniae infection

Atypical pathogens Mycoplasma pneumoniae and Chlamydophila pneumoniae play an important role in community-acquired pneumonia. However, it has been pointed out that positive enzyme-linked immunosorbent assay (ELISA, Hitazyme C. pneumoniae) IgM reactivity is frequent among M. pneumoniae pneumonia patients. To clarify the reactivity of ELISA IgM in M. pneumoniae pneumonia, findings were compared with immunoblotting, ELNAS Plate C. pneumoniae (ELNAS) and the micro-immunofluorescence (MIF) test. Ninety-eight serologically confirmed cases with M. pneumoniae pneumonia and 10 cases with C. pneumoniae pneumonia were enrolled in this study. C. pneumoniae IgM-positive cases measured by the ELISA were observed in 30 (30 %) patients with M. pneumoniae pneumonia. However, there were no positive cases by immunoblotting, ELNAS, or MIF test. These cases determined to be IgM positive only in the ELISA were all negative by another serological test, recombinant enzyme immunoassay (rEIA), and these positive results in the ELISA were considered to be false-positive reactions. In contrast, IgM-positive findings in patients with C. pneumoniae pneumonia did not show any positive reaction in M. pneumoniae antibody titer. ELISA showed a high frequency of false-positive findings in patients with M. pneumoniae pneumonia, which included false-positive cases with a high titer for IgM. To accurately diagnose C. pneumoniae infection in various studies, including respiratory infections, researchers should consider the IgM false-positive reaction with ELISA in patients with suspected atypical pneumonia.     

Polymerase chain reaction for the detection ofPseudomonas aeruginosa,Stenotrophomonas maltophiliaandBurkholderia cepaciain sputum of patients with cystic fibrosis

Occurrence ofPseudomonas aeruginosa,Stenotrophomonas (Xanthomonas) maltophiliaandBurkholderia (Pseudomonas) cepaciain sputum of cystic fibrosis (CF) patients was demonstrated with a simple and rapid polymerase chain reaction (PCR) technique. The PCR was performed with a set of three primer pairs based on 16S rRNA sequences after sputum preparation with dithiothreitol and NaOH lysis. All three pathogens could be individually detected by the use of this technique. To prevent carry-over contamination, dUTP and uracil-N-glycosylase were included in the reaction. The amplicons were visualized by agarose gel electrophoresis. Sputum culture was performed on all samples. Ninety specimens from CF patients were analysed. The sensitivity for the detection ofP. aeruginosawas 37/40 (93%) compared to culture. Bacterial growth ofP. aeruginosawas found in three cases, where PCR amplicons were not detected, while PCR was positive in five cases, where culture did not reveal the presence of this bacterium. For this reason, the specificity was 45/50 (90%). ForS. maltophilia, the PCR was less sensitive than culture (positive in three of six cases). In our series,B. cepaciawas detected by culture in one case and this was also detected by PCR. There were no false-positive PCR results regardingS. maltophiliaorB. cepacia. Thus, combined PCR-based detection of these three clinically relevant bacteria in sputum samples from CF patients can be performed by a reliable technique in a relatively simple manner. The present data indicate a high sensitivity and specificity forP. aeruginosa. The lower sensitivity observed for the detection ofS. maltophiliain sputum andB. cepacia, as estimated from laboratory strains, may depend on PCR conditions and genetic heterogeneity, respectively. The greatest gains with this method can be made when it is used for the early detection ofP. aeruginosain sputum-producing CF patients.     

The effect of inhaled corticosteroids on Chlamydophila pneumoniae and Mycoplasma pneumoniae infection in children with bronchial asthma

The purpose of this study was to clarify whether inhaled corticosteroids (ICSs) increased the infectious load of Chlamydophila pneumoniae and/or Mycoplasma pneumoniae in the respiratory tracts of asthmatic children. We studied a total of 310 outpatients with chronic stable asthma. Real-time polymerase chain reaction (PCR)-positive results for C. pneumoniae were obtained in 21 of 310 (6.8%) throat samples and 21 of 293 (7.2%) nasopharyngeal samples. There was no significant difference in the rate of detection or in the quantity of detection for C. pneumoniae between the ICS group and the non-ICS group, nor were there differences among groups classified by Japanese pediatric guidelines (JPGL) severity criteria. Real-time PCR-positive results for M. pneumoniae were obtained in 60 of 310 (19.4%) throat samples and 49 of 293 (16.7%) nasopharyngeal samples. There was no significant difference in the rate of detection or the quantity of detection between the ICS group and the non-ICS group, nor were there differences among age groups. The results of this research do not support the hypothesis that ICSs influence the infectious load of C. pneumoniae and M. pneumoniae. ICSs did not increase C. pneumoniae or M. pneumoniae infection in the upper respiratory tract, in contrast to the effect of ICSs in causing oral candidiasis. Our data exclude the concern that there is an increase in C. pneumoniae and M. pneumoniae infections due to ICS use, the use of ICSs being the gold standard in the long-term anti-inflammatory treatment of persistent asthma in children and adults.     

IPAzyme Chlamydia and microimmunofluorescence tests for detecting antibodies against Chlamydia trachomatis in women undergoing laparoscopy

Superficial Chlamydia trachomatis infections are diagnosed by antigen detection whereas serological investigations are mainly performed to detect deep-seated infections. In this study the genus-specific IPAzyme and two species-specific microimmunofluorescence (MIF) tests were compared for detecting antibodies against C. trachomatis in women undergoing laparoscopy for diagnostic purposes or for ligation of the fallopian tubes. Microbiological findings were similar in both groups. C. trachomatis was detected in 4 of 38 women with ligation and in 6 of 61 women with diagnostic laparoscopy. Serum IgG antibody titres by IPAzyme were clearly positive in 24 out of 61 of the diagnostic group and in 12 out of 38 of the ligation group. However, 14 (39%) of the 36 IPAzyme-positive results were caused by antibodies against Chlamydia pneumoniae and/or Chlamydia psittaci, only 4 (11%) were caused by anti-C. trachomatis IgG and 8 (22%) were caused by both antibodies as tested by a conventional MIF; in 10 all MIF titres were lower than 1:32. A commercial MIF still containing too much genus-specific lipopolysaccharides was more sensitive, but also more crossreactive than the conventional MIF. IPAzyme IgA were only found in association with positive IPAzyme IgG results. We conclude that in case of presumed deep-seated C. trachomatis infection only sensitive species-specific assays for detecting C. trachomatis antibodies are helpful. IPAzyme and other genus-specific assays cannot be recommended to detect antibodies to C. trachomatis in the serum, because positive results are caused mainly by antibodies against respiratory chlamydiae.     

Salmonella infections in a cancer center

Data concerning 40 patients hospitalized in a cancer center andSalmonella infection were analyzed. Hematological malignancy was present in 24 patients (60%) and solid tumor in 14 patients (35%). Among the predisposing factors, antineoplastic chemotherapy was the most frequent (60%) followed by antacid use (47.5%), corticosteroids (37.5%), granulocytopenia below 500 neutrophils/l (15%), surgery (10%) and splenectomy (2.5%). Bacteremia was the most frequent clinical syndrome accounting for 42.5% of the patients. Focal infection, enteritis and carrier state accounted for the remaining 30%, 20% and 7.5% respectively.Salmonella typhimurium andS. dublin represented 65% of the isolates, with clear association between serotypedublin and bacteremia. AllS. dublin isolates were resistant to chloramphenicol. Amongdublin andtyphimurium serotypes, 20% the isolates were resistant to the traditional antibiotics used in salmonellosis (ampicillin, chloramphenicol, cotrimoxazole). All strains were susceptible in vitro to cephalosporins. The frequency of relapse was 15% and the overall mortality (within 30 days) attributed toSalmonella infection was 15%.     

Diagnosis of Legionella pneumophila,Mycoplasma pneumoniae,or Chlamydia pneumoniae lower respiratory infection using the polymerase chain reaction on a single throat swab specimen

Diagnosis of Mycoplasma pneumoniae and Chlamydia pneumoniae lower respiratory infections using DNA amplification by polymerase chain reaction (PCR) on throat swab specimens has been reported. In this study we determined the sensitivity of the detection of Legionella pneumophila in simulated throat swab specimens by PCR. Next, we compared the sensitivity and specificity of a single throat swab PCR with the current tests for diagnosis of Legionella spp., M. pneumoniae, and C. pneumoniae in patients with lower respiratory tract infections. Patients' work-up included: (a) throat swab speciment for Legionella spp., M. pneumoniae, and C. pneumoniae PCR; (b) throat swab specimen for C. pneumoniae, culture; (c) sputum specimen for L. pneumophila direct fluorescent antibody and culture; (d) urine specimen for L. pneumophila serogroup 1 antigen detection; and (e) serum specimen for L. pneumophila, M. pneumoniae, and C. pneumoniae acute and convalescent antibody titers. A total of 155 patients with lower respiratory infection were enrolled in this prospective study. Throat swab PCR was positive for Legionella spp. in five of the six patients with legionellosis, indicating the presence of this organism in the oropharynx of patients with Legionnaires disease. Mycoplasma pneumoniae PCR was positive in eight of the nine patients with mycoplasma infection. Chlamydia pneumoniae PCR was positive in the two patients with C. pneumoniae infection. None of the other 138 patients with negative PCR had other positive confirmatory tests for respiratory infection by these three organisms (100% specificity). PCR was able to detect 15 of the 17 infected (88.2%). Results of this investigation indicate that PCR on a single throat swab specimen is a rapid, sensitive, and specific test that may greatly simplify the diagnosis of lower respiratory infection caused by Legionella spp., Mycoplasma pneumoniae, or C. pneumoniae.     

The use and performance of oral-throat rinses to detect pharyngeal Neisseria gonorrhoeae and Chlamydia trachomatis infections

Gonococcal and chlamydial infections in the pharynx can occur as a consequence of oral sex. Currently, diagnosis of these infections typically requires a swab specimen to be collected from the posterior pharynx. However, we assessed the diagnostic adequacy of using commercial mouthwash or water as an oral-throat rinse and subsequent testing with a nucleic acid amplification test (Gen-Probe APTIMA Combo 2 assay; Gen-Probe, San Diego, CA). Mouthwash and water samples, spiked with varying amounts of gonorrhea and chlamydia, remained positive for both organisms for up to 2 weeks after storage at room temperature and 37 degrees C. A clinical trial compared the test performance of oral-throat rinses to pharyngeal swabs among 561 (250 mouthwash, 311 water) gay and other men who have sex with men. Participants were also surveyed to assess the acceptability, preference, and feasibility of oral-throat rinses in a clinical setting. The prevalence of pharyngeal gonorrhea and chlamydia were 9.5% (53/556) and 1.4% (8/561), respectively. Compared with the pharyngeal swab, mouthwash oral-throat rinses had a sensitivity and specificity for the detection of gonorrhea of 72% and 99.1%, respectively, whereas water had 82% and 99.7%, respectively. Chlamydia prevalence was too low for reliable assessments of test performance. Study participants found oral-throat rinses acceptable, preferable, and feasible when compared with pharyngeal swabs. Further study is needed to investigate discordant results and improve the sensitivity of oral-throat rinses.     

Characterization of children with <Emphasis Type="Italic">Mycoplasma pneumoniae</Emphasis> infection detected by rapid polymerase chain reaction technique

We used a new polymerase chain reaction (PCR) system to identify the 16S rRNA gene of Mycoplasma pneumoniae and to diagnose lower respiratory tract infections caused by the microorganism. Nasopharyngeal swabs collected from 21 patients (22 episodes) tested positive for M. pneumoniae with the PCR. The age distribution of the patients was between 2 and 13 years. The diagnosis, including concomitant infection, was as follows: pneumonia (n = 11), acute bronchitis (n = 10), bronchial asthma (n = 4), and acute otitis media (n = 1). Six patients had bacterial superinfections. Positive findings for M. pneumoniae were noted together with exacerbation of asthma symptoms, suggesting that M. pneumoniae infection may play the role of an inducer. The PCR system constructed by us will contribute to revealing the clinical features of M. pneumoniae infection, and as a result, an appropriate chemotherapeutic agent can be chosen. We propose the usefulness of this PCR system to detect the microorganism in younger children.     

肺炎衣原体感染对慢性阻塞性肺病患者T淋巴细胞亚群的影响

目的:探讨肺炎衣原体(CP)感染对慢性阻塞性肺病(COPD)患者T淋巴细胞亚群的影响。方法:选择COPD急性加重期患者176例,正常对照组46例。采用微量免疫荧光试验检测血清CP抗体IgG、IgA、IgM,采用流式细胞仪测定两组的外周血CD3 、CD4 、CD8 T淋巴细胞。结果:观察组急性CP感染率为27.3%,慢性CP感染率为19.3%,与对照组比较有显著差异(P<0.01)。CD3 、CD4 细胞在各组间无差异,COPD患者中慢性CP感染组的CD8 细胞升高、CD4 /CD8 比值降低,较对照组有明显差异(P<0.01),而急性CP感染组和阴性组的CD8 细胞及CD4 /CD8 比值与对照组差异不明显。结论:CP感染是COPD急性加重的重要诱因,CP感染特别是慢性感染是引起COPD患者细胞免疫功能紊乱的重要原因,而这种细胞免疫功能的紊乱可能参与了COPD的发病。     

A 3-year prospective study of a urinary antigen-detection test for <Emphasis Type="Italic">Streptococcus pneumoniae</Emphasis> in community-acquired pneumonia: utility and clinical impact on the reported etiology

To evaluate the efficacy of a rapid immunochromatographic membrane test (ICT) for the detection of Streptococcus pneumoniae urinary antigen for diagnosing S. pneumoniae pneumonia, ICT was performed with urine samples using the Binax NOW Streptococcus pneumoniae kit at the time of admission. The results were compared with those from conventional microbiological studies. Three hundred and forty-nine adult patients with CAP who were admitted to the hospital were studied prospectively between February 2001 and January 2004. The ICT test was positive in 115 (33.0%) of 349 patients enrolled into the study and in 63 (75.9%) of 83 patients with pneumococcal pneumonia confirmed by conventional methods. The test revealed a sensitivity of 75.9% and a specificity of 94.0% with conventional microbiological criteria used as the reference standard. The positive predictive value was 91.3%, and the negative predictive value was 82.6%. The clinical features of 53 patients in whom ICT was positive and no pathogen was identified showed no significant difference from those of 83 patients who had pneumococcal pneumonia identified by conventional methods. The diagnostic yield of pneumococcal pneumonia was increased up to 38.9% using ICT combined with conventional methods. The Binax NOW ICT to detect S. pneumoniae urinary antigen is therefore a rapid and useful method for diagnosing pneumococcal pneumonia. Induction of ICT will prove the predominance of S. pneumoniae in the etiology of CAP.     

Exogenous or endogenous reservoirs of nosocomialPseudomonas aeruginosa andStaphylococcus aureus infections in a surgical intensive care unit

Objective A 4 month prospective study was performed to assess the incidence and routes of endogenous or exogenous colonization and nosocomial infection caused byStaphylococcus aureus andPseudomonas aeruginosa in surgical critically ill patients.Design A total of 4634 specimens ware obtained. Patient's nasal, scalp, and rectal swabs as well as tracheal secretion (TS) were cultured every second day beginning on the day of admission. Nasal swabs and hand cultures of the personnel as well as cultures from gowns were also taken. all isolates ofS. aureus were phage typed and 116 of these isolates were also plasmid typed.P. aeruginosa isolates were sero-and pyocin typed. Resistance patterns were determined in all isolates.Setting The suty was carried out in the surgical intensive care unit (SICU) of an teaching hospital.Patients During the study period each patient (a total of 153 patients) admitted to the SICU entered the study.Results P. aeruginosa andS. aureus colonisation rate on admission were 5% and 36.5% respectively. Only 10 patients (6.5%) were colonized withP. aeruginosa during hospitalization, and only 7 patients (4.5%) acquiredS. aureus in the surgical intensive care unit (SICU). The most common primary colonisation site ofP. aeruginosa was the rectum, whereasS. aureus was predominantly found in nasal cultures. Horizontal transmission ofS. aureus occured in only 2 patients.Conclusion The study suggests that colonisation withP. aeruginosa andS. aureus occurs from endogenous rather than from exogenous sources and that the endogenous acquisition of both bacteria play a more important role in development of nosocomial infections than the exogenous route of transmission.