Community-acquired pneumonia with rhabdomyolysis]

We assessed the frequency and etiology of rhabdomyolysis in patients with community-acquired pneumonia. In 594 patients with community-acquired pneumonia whose serum CPK were measured, 25 patients (2.4%) were found to have rhabdomyolysis. Including 4 patients with mixed infections, the etiologies in 25 patients with community-acquired pneumonia with rhabdomyolysis were as follows: Legionella species, 11 patients (44%); Influenza virus, 6 (24%); Streptococcus pneumoniae, 4 (16%); Chlamydia psittaci, 3 (12%); Mycoplasma pneumoniae, 2 (8%); unknown 3 patients (12%). The rates of rhabdomyolysis for each etiologic category were as follows: Legionella species, 26.8% (11/41); Chlamydia psittaci, 21.4% (3/14); Influenza virus, 9.5% (6/63) ; Streptococcus pneumoniae, 4.7% (4/85);Mycoplasma pneumoniae, 3.1% (2/65). Renal dysfunction with a serum creatinine concentration greater than 1.5 mg/dl occurred in 6 patients (24%). Our experience illustrates that 5 pathogens can cause rhabdomyolysis in patients with community-acquired pneumonia. Legionella species are the most common organisms followed by Influenza virus, Streptococcus pneumoniae, Chlamydia psittaci, Mycoplasma pneumoniae.     

Atypical pathogens in adult patients admitted with community-acquired pneumonia in Korea

This study examined the prevalence of atypical pathogens causing community-acquired pneumonia (CAP) in Korea. We collected sera and clinical data for a period of 1 year for the adult patients consecutively admitted to Chunchon Sacred Heart Hospital with CAP. The diagnosis was made using serologic methods to detect antibodies for Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella spp., Chlamydia psittaci, and Coxiella burnetii. Among 81 recruited patients, C. pneumoniae (n = 10, 12.3%) was the leading cause of illness, followed by M. pneumoniae (n = 7, 8.6%). One case of C. burnetii pneumonia was detected, but there were no cases of Legionella spp. or C. psittaci. Three cases of C. pneumoniae pneumonia were co-infected with either M. pneumoniae or C. burnetii. There was no significant difference between atypical pneumonia and non-diagnosed pneumonia in terms of clinical manifestations. In conclusion, of the atypical pathogens causing CAP, C. pneumoniae and M. pneumoniae appear to be the important etiologic pathogens in Korea.     

Chlamydia species as a cause of community-acquired pneumonia in Canada.

Chlamydia pneumoniae has been implicated as a cause of community-acquired pneumonia (CAP) in several studies. However, there has been no comprehensive study of the role of Chlamydia species (C. pneumoniae, C. psittaci (avian and feline strains) and C. pecorum) as a cause of CAP. The aim of the present study was to determine the role of C. pneumoniae, C. psittaci and C. pecorum as causes of CAP. A prospective cohort observational study of CAP was conducted at 15 teaching centres in eight Canadian provinces between January 1996-October 1997. Acute (n=539) and convalescent (n=272) serum samples were obtained for determination of antibody titres to C. pneumoniae, C. psittaci, C. pecorum, C. trachomatis, Mycoplasma pneumoniae, Legionella pneumophila serogroups I-VI, Streptococcus pneumoniae and various respiratory viruses. Twelve of 539 (2.2%) patients had acute C. pneumoniae pneumonia and an additional 32 (5.9%) had possible acute infection. C. pneumoniae was the sole pathogen in 16 of 42 (38.1%) of these patients. The most common copathogens were S. pneumoniae, respiratory syncytial virus and influenza virus type A. C. pneumoniae pneumonia patients were older and more likely to show congestive heart failure compared to bacteraemic S. pneumoniae patients. The latter had a lower mean diastolic blood pressure, a higher white blood cell count and a lower arterial carbon dioxide tension. Two patients had antibody titres suggestive of recent infection with the feline strain of C. psittaci. Although numerically Chlamydia pneumoniae is an important cause of community-acquired pneumonia, no distinctive clinical features associated with this pathogen were detected in the present study. Feline Chlamydia psittaci may cause a few cases of community-acquired pneumonia. Avian Chlamydia psittaci should be considered only if there is a compatible epidemiological history.     

北京地区成人社区获得性肺炎非典型病原体流行病学调查

目的　对引起社区获得性肺炎 (CAP)的病原体进行流行病学调查 ,加强对非典型致病原重要性的认识。方法　收集 2 0 0 1年 11月至 2 0 0 2年 6月CAP患者共 10 3例。分别检测患者急性期及恢复期肺炎支原体、嗜肺军团菌、肺炎衣原体血清抗体。应用聚合酶链反应 (PCR)分别扩增肺炎支原体P1黏附蛋白基因及肺炎衣原体 16SrRNA基因。应用酶免疫测定 (EIA)方法检测尿中嗜肺军团菌抗原。取患者急性期痰标本进行细菌培养 ,应用常规方法分离鉴定细菌。结果　 10 3例CAP患者 ,病原体检出率为 48.5%。 2 3例 (2 2 .3 % )检出肺炎支原体 ,3例 (2 .9% )检出嗜肺军团菌 ,2例 (1.9% )检出肺炎衣原体。 12例分离出肺炎链球菌 (11.7% )、9例分离出流感嗜血杆菌 (8.7% )、7例分离出肺炎克雷伯菌 (6.8% )。 6例患者存在混合感染 (5.8% ) ,其中 5例为肺炎支原体混合其他病原体。结论　非典型病原体尤其是肺炎支原体感染在CAP中占据重要地位 ;肺炎链球菌和流感嗜血杆菌仍为常见的致病细菌 ;混合感染不容忽视     

The etiology of community-acquired pneumonia at an urban public hospital: influence of human immunodeficiency virus infection and initial severity of illness.

In a prospective study, the etiology of community-acquired pneumonia (CAP) was investigated among consecutive patients admitted to an academic, urban public hospital in Seattle. The study population was uniquely young, was predominantly male, and had high rates of homelessness, cigarette smoking, alcoholism, injection drug use, and human immunodeficiency virus (HIV) infection. Leading causes of CAP among HIV-negative patients were aspiration, followed by Streptococcus pneumoniae, Legionella species, and Mycoplasma pneumoniae. Among HIV-positive patients, Pneumocystis carinii, Mycobacterium tuberculosis, S. pneumoniae, and M. pneumoniae were the most common etiologic agents. Severe CAP was associated with typical bacterial infections and aspiration pneumonia but not Legionella infection among HIV-negative patients and with Pseudomonas aeruginosa infections among HIV-positive patients. These findings emphasize the need to tailor empirical antibiotic therapy according to local patient populations and individual risk factors and highlight the importance of recognizing underlying HIV infection in patients who are hospitalized with CAP.     

Microbial etiology of community-acquired pneumonia in the adult population of 4 municipalities in eastern Finland.

To determine the etiology of community-acquired pneumonia in the adult population of a defined area, specific antibody responses in paired serum samples, levels of circulating pneumococcal immune complexes in serum samples, and pneumococcal antigen in urine were measured. Samples (304 paired serum samples and 300 acute urine samples) were obtained from 345 patients > or =15 years old with community-acquired, radiologically confirmed pneumonia, which comprised all cases in the population of 4 municipalities in eastern Finland during 1 year. Specific infecting organisms were identified in 183 patients (including 49 with mixed infection), as follows: Streptococcus pneumoniae, 125 patients; Haemophilus influenzae, 12; Moraxella catarrhalis, 8; chlamydiae, 37 (of which, Chlamydia pneumoniae, 30); Mycoplasma pneumoniae, 30; and virus species, 27. The proportion of patients with pneumococcal infections increased and of those with Mycoplasma infections decreased with age, but for each age group, the etiologic profile was similar among inpatients and among outpatients. S. pneumoniae was the most important etiologic agent. The annual incidence of pneumococcal pneumonia per 1000 inhabitants aged > or =60 years was 8.0.     

Chlamydia and Mycoplasma serology in respiratory tract infections of children

One of the challenges in planning the treatment of respiratory tract infection in children is identifying the causative agent. The objective of the present study was to investigate the incidence of Mycoplasma and Chlamydia in the etiology of respiratory tract infections of children. The present study included 100 children, three months to 12 years of age, admitted to the outpatient department of pediatrics with such respiratory symptoms as fever, cough and respiratory distress. Following a detailed clinical history and physical examination, complete blood count, erythrocyte sedimentation rate, peripheral blood smear and chest X-ray were obtained from each patient. At admission, IgG and IgM for Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia trachomatis and Chlamydia psittaci were determined serologically. Positive antibody titer was found for Chlamydia and Mycoplasma in 18 (18%) of the patients. It was found that 2% of the patients had acute C. pneumoniae infection. When the subjects who had infections in the past or had re-infection were also considered; 6% were infected with C. pneumoniae, 3% with C. trachomatis, 1% with C. psittaci and 8% with M. pneumoniae. The presence of eosinophilia (> or = 4%) or the presence of siblings in the house were considered as factors favoring Chlamydial infections. High antibody titers for M. pneumoniae and C. pneumoniae were found more frequently after the age of two. Patients older than two years should be evaluated carefully for antibiotic treatments against atypical agents in pediatric lower respiratory tract infections.     

中国城市成人社区获得性肺炎665例病原学多中心调查

目的 研究引起社区获得性肺炎（CAP）的病原体分布及患者入选前是否应用抗生素、肺炎患者预后研究组（PORT）分级等的情况，同时检测常见病原菌的耐药性。方法 入选2003年12月至2004年11月中国7个城市12个中心的665例CAP患者并进行病原体检测。病原体确定诊断的阳性判断标准为：（1）合格痰标本培养出1株或多株细菌；（2）血培养检出病原体；（3）间隔2～4周采集的2次标本的血清肺炎支原体、肺炎衣原体或嗜肺军团菌抗体滴度呈现4倍或4倍以上增高或降低。应用琼脂稀释法对常见病原菌进行最低抑菌浓度（MIC）检测。结果 在610例同时进行了细菌培养和血清学检测的患者中，肺炎支原体是最常见的病原体，阳性率为20．7％（126例），其后依次为肺炎链球菌10．3％（63例）、流感嗜血杆菌9．2％（56例）、肺炎衣原体6，6％（40例）、肺炎克雷伯杆菌6.1％（37例）、嗜肺军团菌5.1％（31例）、金黄色葡萄球菌3．8％（23例）、大肠杆菌1．6％（10例）、卡他莫拉菌1.3％（8例）、铜绿假单胞菌1．0％（6例）。在195例细菌培养阳性患者中，共有10．2％（62例）合并非典型病原体感染。69株肺炎链球菌，对青霉素、阿奇霉素和莫西沙星的不敏感率分别为20．3％、75．4％和4．3％。结论 非典型病原体尤其是肺炎支原体感染在CAP中占据重要地位；细菌合并非典型病原体的混合感染占10．2％。肺炎链球菌、流感嗜血杆菌仍为常见的致病细菌，我国致CAP肺炎链球菌对大环内酯类抗生素的耐药率高达75．0％以上，对青霉素的不敏感率为20，3％．     

A case of pneumonia due to coinfection by Mycoplasma pneumoniae and Chlamydia pneumoniae]

Few cases of Mycoplasma pneumoniae and Chlamydia pneumoniae coinfection in pneumonia have been reported in adults. We report a case of such a double infection in a young adult. A 16-year-old boy was admitted to our hospital with dry cough and fever. Laboratory findings revealed elevated serum GOT and GPT levels. The patient had been administered a beta-lactam antibiotic before admission to our hospital. Antibodies to M. pneumoniae were significantly elevated. Titers of IgM and IgG specific for C. pneumoniae titer were high, as measured by the enzyme-linked immunosorbent assay method. The patient was treated with clarithromycin and discharged after a satisfactory recovery. M. pneumoniae and C. pneumoniae may act as cofactors in community-acquired pneumonia. Further studies are needed to clarify the relationships of these pathogens to community-acquired pneumonia.     

Clinical analysis of pneumonia in the elderly in a community hospital--comparison of community-acquired pneumonia and nosocomial pneumonia]

We experienced 530 elderly cases with pneumonia among 930 patients with pneumonia in Kawasaki Medical School Kawasaki Hospital between April 1986 and September 1998. Clinical analysis of all these patients and a comparison of one group consisting of 418 patients with community-acquired pneumonia and another group composed of 112 patients with nosocomial pneumonia were performed. In all of the elderly patients with pneumonia, respiratory symptoms and inflammatory findings were less frequent, but were frequent for those in poor general and nutritional condition. The causative microorganism was isolated in 42% of these patients. Streptococcus pneumoniae, MSSA and Klebsiella pneumoniae were frequently isolated from the sputum of the patients with community-acquired pneumonia, while Methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Methicillin-sensitive Staphylococcus aureus (MSSA) were frequently isolated from that of nosocomial pneumonia patients. Mycoplasma pneumoniae, Chlamydia pneumoniae and some viruses were less frequent for patients in both groups. Although many intravenous antibiotics, such as cephem or carbapenem were administered to patients in both groups, the prognosis was relatively good for those with community acquired pneumonia but was extremely poor for those with nosocomial pneumonia despite mechanical ventilation or steroid pulse therapy for many patients.     

非典型病原体所致重症社区获得性肺炎的诊断与治疗

重症社区获得性肺炎病情进展迅速、病死率高,而非典型病原体(如肺炎支原体、肺炎衣原体、军团菌等)是社区获得性肺炎的主要致病菌,因此及时诊断、寻找有效的药物及其他相关治疗手段对及时挽救患者的生命至关重要。文章主要就非典型病原体所致重症社区获得性肺炎的诊断和治疗进行阐述。     

非典型病原菌致成人社区获得性肺炎患者的临床特点分析

目的 研究非典型病原菌感染在成人住院社区获得性肺炎中的重要地位,并对其临床特点进行分析.方法 收集2005年5月至2008年5月来自国内多中心的153例成人社区获得性肺炎住院患者急性期及恢复期双份血清和急性期痰标本,采用间接免疫荧光法检测肺炎衣原体IgG抗体及嗜肺军团菌IgG、IgA及IgM混合抗体滴度,采用被动凝集法检测肺炎支原体IgG、IgA及IgM混合抗体滴度,同时对153份急性期痰标本进行普通细菌培养.用回顾性分析方法了解非典型病原菌在成人社区获得性肺炎住院患者中的地位.结果 153例血清学检测结果中符合非典型病原菌致社区获得性肺炎诊断标准的52例(34.0%),其中47例为单一非典型病原菌感染,其中肺炎衣原体38例,肺炎支原体4例,嗜肺军团菌5例;5例为2种非典型病原菌混合感染,其中肺炎衣原体+肺炎支原体2例,肺炎衣原体+嗜肺军团菌3例;52例中合并细菌感染者11例.结论 非典型病原菌(肺炎衣原体、肺炎支原体及嗜肺军团菌)为成人住院社区获得性肺炎的重要致病菌,以肺炎衣原体为主,同时不能忽视合并细菌感染情况的存在.     

The spectrum of pneumonia in 1983 at the Riyadh Armed Forces Hospital

The agents causing pneumonia have been assessed in 112 adult patients admitted to the Armed Forces Hospital in Riyadh during a period of one year: pathogens were identified in 78 patients (69.6%). Sputum culture produced a significant isolate in 60 patients (53.5%), and in 17 (15.2%) the causative agent was suggested by serological tests. Streptococcus pneumonia was the commonest infecting agent (21.4%). Pneumonia due to Mycobacterium tuberculosis was diagnosed in eight patients, to Mycoplasma pneumoniae in seven, to Chlamydia psittaci in two and to Legionella pneumophila in one. Three renal transplant patients had pneumonia caused by Staphylococcus aureus, cytomegalovirus and Pneumocystis carinii respectively, the latter diagnosed by lung biopsy. Two patients with acute Brucella melitensis infections developed pneumonia. In 34 patients (30.4%) the causative organism was not identified. Most of the epidemiological and aetiological factors studied in this survey are inconsistent with previous reports on pneumonia from western countries. For example, the commonest age group affected was younger than in western series. Tuberculous and brucella pneumonia, not commonly seen in western countries, are diagnoses to be considered in Saudi Arabia.     

用DNA探针检测肺炎衣原体

目的建立一种敏感而特异的肺炎衣原体分子生物学检测方法。方法用ＰＣＲ扩增约４６０ｂｐ的肺炎衣原体种特异性基因片段并标记成探针,建立ＤＮＡ探针杂交检测肺炎衣原体的方法。结果：探针只与肺炎衣原体ＡＲ－３９、ＶＲ１３１０株ＤＮＡ呈阳性杂交斑点,与肺炎衣原体ＡＲ－３９株全ＤＮＡＰｓｔＩ酶切片段在２．５ｋｂ处有一阳性杂交带,与其它两种衣原体、Ｑ热立克次体、嗜肺军团菌、大肠杆菌、绿脓杆菌、金黄色葡萄球菌ＤＮＡ斑点膜无阳性杂交信号。从１５２例有呼吸道疾患的住院病人鼻咽拭子和肺泡灌洗液中检出阳性１８例,阳性率１２％。结论本文建立的ＤＮＡ探针检测肺炎衣原体方法具有较高的敏感性和特异性,可用于批量临床标本的检测。     

Azithromycin: Single 1.5g dose in the treatment of patients with atypical pneumonia syndrome—A randomized study

Summary An open comparative study was undertaken in order to assess the efficacy and safety of a single dose of azithromycin in the treatment of community-acquired atypical pneumonia. A total of 100 adult patients with atypical penumonia syndrome were randomized to receive 1.5 g of azithromycin as a single dose, or 500 mg once daily for 3 days. The presence ofMycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia psittaci, Coxiella burnetii, andLegionella pneumophila infection was diagnosed by serological tests. Control clinical examinations were performed 72h, 10–12 days and 4 weeks after treatment initiation. Among 96 patients (48 in each group) who were evaluable for clinical efficacyM. pneumoniae infection was confirmed in 24,C. pneumoniae in nine,C. psittaci in five,C. burnetii in six, andL. pneumophila in five. Forty-seven patients (97.9%) in each group were cured. Side effects were observed in two patients in the single-dose group, and one patient in the 3-day group. In conclusion, a single 1.5 g dose of azithromycin may be an alternative to the standard 3-day azithromycin regimen in the treatment of outpatients with atypical pneumonia syndrome.     

Epidemiology of micro-organisms responsible for community-acquired pneumonia]

Pneumonias occupy a prominent situation among lower respiratory tract infections where they are remarkable for their potential mortality and for our relative knowledge of the responsible micro-organisms. Analysis and synthesis of each series published must answer several questions, such as: what are the lung diseases considered? which investigations have been performed? which criteria of imputability have been used? in which patients has the study been carried out? in which place, which period and which structure? In spite of methodological lacunae and of the inhomogeneous answers to the questions asked, there is some concordance between the series found in the literature. Thus, more than 90% of community-acquired pneumonias with microbiological identification are caused by Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Legionella pneumophila, Chlamydia psittaci (or pneumoniae), or Influenza A virus.     

Clinical analysis of community-acquired pneumonia in the elderly

OBJECTIVE: To evaluate the clinical features, etiology, and outcome of patients over 65 years old hospitalized for community-acquired pneumonia. PATIENTS: Eighty-four patients (50 males, 34 females) hospitalized for community-acquired pneumonia in Kawasaki Medical School Kawasaki Hospital between April 1998 and March 2000. RESULTS: Most of the patients had respiratory symptoms or signs, but over one-third also had atypical symptoms of pneumonia such as dyspnea, consciousness disturbance, and gastrointestinal symptoms. The causative microorganisms were identified in 48% of these patients. Streptococcus pneumoniae (13%), respiratory viruses (13%), Haemophilus influenzae (8%) and Mycobacterium tuberculosis (8%) were frequently identified, but Mycoplasma pneumoniae was less frequently noted in the elderly. Double infection was recognized in 19 % and a combination of some virus and bacteria in 13%. Treatment consisted of the administration of second or third generation cephalosporin antibiotics intravenously, because antibiotics had already been preadministered in 39%. The prognosis was poor (mortality rate 9%) for the elderly with community-acquired pneumonia despite mechanical ventilation in 8%. CONCLUSIONS: Although the range of microorganisms causing community-acquired pneumonia differed slightly from that in previous reports; namely, lower frequency of Chlamydia pneumoniae and Legionella pneumophila, it is suggested that the initial antibiotic treatment should always cover S. pneumoniae and H. influenzae. In addition, since a prevalence of virus infections related to the increase in community-acquired pneumonia in the elderly was found in this study, the routine use of influenza vaccine and pneumococcal vaccines in the elderly is recommended to reduce the high mortality rate.     

Chlamydia pneumoniae is an important cause of community-acquired pneumonia in school-aged children: serological results of a prospective, population-based study.

The aetiology of community-acquired pneumonia in childhood was studied in the total population of 8851 children in the area of 4 municipalities in eastern Finland. All cases of community-acquired pneumonia (n = 201) were registered during a surveillance period of 12 months between September 1, 1981 and August 31, 1982. The diagnosis of pneumonia was verified radiologically in all identified cases. The diagnosis of chlamydial infection was based on an antibody response measured by complement fixation (CF), by enzyme immunoassay (EIA; IgG or IgM) or by microimmunofluorescence (MIF; IgG or IgM), and the diagnosis of mycoplasmal infection on CF alone. In total, 29 cases of Chlamydia sp. infection were diagnosed; 20 were caused by Chlamydia pneumoniae. Thus, C. pneumoniae was an aetiological agent in 10%, of the 201 pneumonia cases: the proportion was 9% for children aged 5-9 y and 31% for those aged 10 y or more. In the study population, the total incidence of C. pneumoniae pneumonia was 2.3/1000/y. Mycoplasma pneumoniae serology (CF) was positive in 44 patients (22%); the total incidence of M. pneumoniae pneumonia was 5.0/1000/y. Serological evidence of both Chlamydiae and M. pneumoniae was detected in 9 (41%) patients. Our results indicate that C. pneumoniae is an important cause of community-acquired pneumonia in school-aged children. Diagnostic serological response to Chlamydia species or M. pneumoniae was found in 42% of pneumonia patients between 5 and 9 y of age and in 67% of patients aged 10 y or more. Thus, we suggest that macrolides should be considered as an empirical antimicrobial treatment for community-acquired pneumonia, especially in school-aged outpatients.     

Role of Chlamydia, mycoplasma and cytomegalovirus infection in the development of coronary artery disease

AIM: To assess relationship between some infection factors and presence of coronary heart disease. MATERIAL: Patients with myocardial infarction (n=56), unstable angina (n=50), stable angina (n=50) and age - matched controls (n=49). METHODS: Levels of IgG, IgM, IgA antibodies to Chlamydia pneumonia, Chlamydia trachomatis, Chlamydia psittaci, IgG, IgM antibodies to Cytomegalovirus, and also of antibodies and antigen to Mycoplasma pneumoniae were measured in blood serum. RESULTS: Compared with controls patients with coronary heart disease had higher frequency of seropositivity to Chlamydia pneumonia, Mycoplasma pneumonia and Cytomegalovirus (p< 0.05 ) and similar levels of seropositivity to Chlamydia trachomatis and Chlamydia psittaci. Infectious burden (quantity of antibodies per one patient) was significantly higher in patients with myocardial infarction, unstable and stable angina than in controls (1.58, 1.42, 1.41 and 0.95, respectively). CONCLUSION: Our results confirm presence of association between infection and coronary heart disease.