Detection of Pneumococcal DNA in Blood by Polymerase Chain Reaction for Diagnosing Pneumococcal Pneumonia in Young Children From Low- and Middle-Income Countries
Susan C. MorpethMaria Deloria KnollJ. Anthony G. ScottDaniel E. ParkNora L. WatsonHenry C. BaggettW. Abdullah BrooksDaniel R. FeikinLaura L. HammittStephen R. C. HowieKaren L. KotloffOrin S. LevineShabir A. MadhiKatherine L. O’BrienDonald M. TheaPeter V. AdrianDilruba AhmedMartín AntonioCharatdao BunthiAndrea N. DeLucaAmanda J. DriscollLouis Peter GithuaMelissa M. HigdonGeoff KahnAngela KaraniRuth A. KarronGeoffrey KwendaSirirat MakprasertRazib MazumderDavid P. MooreJames MwansaSammy NyongesaChristine ProsperiSamba O. SowBoubou TambouraToni WhistlerScott L. ZegerDavid R. Murdoch
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Abstract:
We investigated the performance of polymerase chain reaction (PCR) on blood in the diagnosis of pneumococcal pneumonia among children from 7 low- and middle-income countries. We tested blood by PCR for the pneumococcal autolysin gene in children aged 1–59 months in the Pneumonia Etiology Research for Child Health (PERCH) study. Children had World Health Organization–defined severe or very severe pneumonia or were age-frequency–matched community controls. Additionally, we tested blood from general pediatric admissions in Kilifi, Kenya, a PERCH site. The proportion PCR-positive was compared among cases with microbiologically confirmed pneumococcal pneumonia (MCPP), cases without a confirmed bacterial infection (nonconfirmed), cases confirmed for nonpneumococcal bacteria, and controls. In PERCH, 7.3% (n = 291/3995) of cases and 5.5% (n = 273/4987) of controls were blood pneumococcal PCR-positive (P < .001), compared with 64.3% (n = 36/56) of MCPP cases and 6.3% (n = 243/3832) of nonconfirmed cases (P < .001). Blood pneumococcal PCR positivity was higher in children from the 5 African countries (5.5%–11.5% among cases and 5.3%–10.2% among controls) than from the 2 Asian countries (1.3% and 1.0% among cases and 0.8% and 0.8% among controls). Among Kilifi general pediatric admissions, 3.9% (n = 274/6968) were PCR-positive, including 61.7% (n = 37/60) of those with positive blood cultures for pneumococcus. The utility of pneumococcal PCR on blood for diagnosing childhood pneumococcal pneumonia in the 7 low- and middle-income countries studied is limited by poor specificity and by poor sensitivity among MCPP cases.Keywords:
Pneumococcal pneumonia
Etiology
Pneumococcal infections
Pneumolysin
Pneumococcal pneumonia
Pneumococcal infections
Pathogenesis
Virulence factor
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We studied the bactericidal capacity of the rat lung during the development of pneumococcal pneumonia. Pneumonia was produced in a lower lobe by the intrabronchial instillation of 10 4 Streptococcus pneumoniae cells in buffer. Lung bacterial counts progressively increased, reaching 10 7 per lung within 48 h, and the increase was associated with localized atelectasis and consolidation. Bacterial multiplication was inhibited with tetracycline at various intervals after infection, and the subsequent clearance of pneumococci was determined. Viable pneumococci were rapidly killed by lung defenses if bacterial multiplication was inhibited within 12 h of the onset of infection. No change occurred in the bacterial populationif tetracycline was delayed until 24 h after infection, indicating that pneumococcal killing by lung defenses had ceased. This effect could be reproduced with the addition of pneumococcal capsular polysaccharide to the inoculum, which produced a dose-related inhibition of pneumococcal clearance. The clearance of S. epidermidis was not impaired in the presence of pneumococcal pneumonia or by administration of exogenous capsular polysaccharide. These data indicate that pneumococcal pneumonia causes a marked impairment in lung antipneumococcal defenses within 24 h of the onset of infection. This acquired defect in antibacterial defenses may be due to the accumulation of pneumococcal capsular material in the lungs of infected animals.
Pneumococcal pneumonia
Bacterial pneumonia
Atelectasis
Pneumococcal infections
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Streptococcus pneumoniae is one of most common causes of community-acquired pneumonia. We evaluated a newly available rapid immunochromatographic test to detect S. pneumoniae in urine samples verifying its importance in the diagnosis of pneumococcal pneumonia. Our data, obtained from 104 patients with community-acquired pneumonia, show that Now S. pneumoniae Urinary Test is characterized by a sensitivity value of 77.7%, a specifity of 98.8%: positive and negative predictive values are 93.3% and 95.5%, respectively. In conclusion, Now S. pneumoniae Urinary Test should be a useful test to establish the etiology of community-acquired pneumonia.
Etiology
Pneumococcal pneumonia
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We studied the long-term survival of patients who recovered from pneumococcal pneumonia. Mortality was increased for up to 10 years after documented pneumococcal pneumonia and was greater in proportion to the PORT score at admission and among persons who had bacteremic disease.
Pneumococcal pneumonia
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Summary points
Mortality from bacteraemic pneumonia has remained unchanged at 25% over the last 40 years Globally, Streptococcus pneumoniae causes over 1 million deaths in children under the age of 5 years Antibiotic resistant strains of S pneumoniae are increasing world wide. In Spain over 50% of isolates are resistant to one or more antibiotics Patients at increased risk of severe pneumococcal infection should be:Pneumococcal pneumonia
Pneumococcal infections
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Streptococcus pneumoniae is the leading cause of community-acquired pneumonia worldwide and is the most likely causative pathogen in patients with community-acquired pneumonia admitted to the intensive care unit. Bacteremic pneumococcal pneumonia is an advanced stage of severe pneumococcal pneumonia. Improvement in the management of bacteremic pneumococcal pneumonia has the potential for improving the survival for severe pneumococcal pneumonia.Non-culture methods, especially the Binax urinary antigen test, can increase the diagnostic yield for pneumococcal pneumonia, allowing targeted antimicrobial therapy (specifically penicillin). In-vitro resistance to penicillin has increased over the past decade; however, it has not led to clinical failure when used for pneumococcal pneumonia.Hospitalized patients with community-acquired pneumonia should have blood cultures obtained to confirm the possibility of bacteremic pneumococcal pneumonia. Based on pharmacodynamic properties, parenteral penicillin remains the drug of choice to treat pneumococcal pneumonia regardless of in-vitro resistance. Combination antimicrobial therapy will likely improve survival of patients with bacteremic pneumococcal pneumonia among the subset of critically ill patients.
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Bacterial pneumonia
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Pneumococcal pneumonia
Case fatality rate
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Carriage
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Community-acquired pneumonia (CAP) is an important cause of morbidity and mortality in all age groups throughout the world. Bacterial pneumonia is the most described, with Streptococcus pneumoniae being the most important pathogen in all age groups. Viruses are also recognised as important causes of CAP both in children and adults. Viral pneumonia account for 13 - 50% of single pathogen diagnosed community-acquired pneumonia cases and 8 -27% of mixed bacterial-viral pneumonia.
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Bacterial pneumonia
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Pneumococcal infections
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