Abstract
The objective of this study was to assess the predictive value of signs, symptoms, and rapidly available laboratory parameters for pneumococci in community-acquired pneumonia (CAP). A prospective study on patients with CAP who were admitted to hospital was conducted. Clinical and laboratory data were collected according to a protocol. Two hundred sixty-eight patients aged 18 years or older, not living in a nursing home or not admitted to hospital within one week of this admission, with a new infiltrate on the chest radiograph consistent with pneumonia were included. According to microbiological and serological tests, patients were allocated to one of two aetiological groups,Streptococcus pneumoniae or “other pathogens”. Seventy-three variables were examined for a correlation with one of the aetiological categories by means of univariate and multivariate analysis. The resulting discriminant function was considered a clinical test for which posttest probabilities for pneumococcal pneumonia were calculated.Streptococcus pneumoniae was demonstrated in 79 patients and other pathogens in 83; no pathogens were detectable in 106 patients. The variables “cardiovascular disease”, “acute onset”, “pleuritic pain”, “gram-positive bacteria in the sputum Gram stain”, and “leucocyte count” correctly predicted the cause of CAP in 80% of all cases in both groups. Depending on the prevalence ofStreptococcus pneumoniae, posttest probabilities for pneumococcal pneumonia were up to 90%. It is concluded that data on history, together with the result of the Gram stain of sputum and the leucocyte count, can help to distinguishStreptococcus pneumoniae from other pathogens causing CAP.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Marrie TJ, Durant H, Yates L: Community-acquired pneumonia. Reviews of Infectious Diseases 1989, 11: 586–599.
Berntsson E, Blomberg J, Lagergard T, Trollfors B: Etiology of community-acquired pneumonia in patients requiring hospitalization. European Journal of Clinical Microbiology 1985, 4: 268–272.
Bohte R, van Furth R, van den Broek PJ: Aetiology of community-acquired pneumonia: a prospective study among adults requiring admission to hospital. Thorax 1995, 50: 543–547.
Research Committee of the British Thoracic Society and Public Health Laboratory Service: Community-acquired pneumonia in adults in British hospitals in 1982–1983: a survey of aetiology, mortality, prognostic factors and outcome. Quarterly Journal of Medicine 1987, 62: 195–220.
Fang GD, Fine M, Orloff J, Arisumi D, Yu VL, Kapoor W, Grayston TJ, Wang SP, Kohler R, Muder RR, Yee YC, Rihs JD, Vickers BS: New and emerging etiologies for community-acquired pneumonia with implications for therapy. Medicine 1990, 69: 307–316.
Musher DM: Infections caused byStreptococcus pneumoniae: clinical spectrum, pathogenesis, immunity, and treatment. Clinical Infectious Diseases 1992, 14: 801–809.
Macfarlane JT: Recent advances in respiratory medicine. Churchill Livingstone, Edinburgh, 1991, p. 109–124.
Marrie TJ: Community-acquired pneumonia. Clinical Infectious Diseases 1994, 18: 501–515.
Macfarlane JT: An overview of community acquired pneumonia with lessons learned from the British Thoracic Society Study. Seminars in Respiratory Infections 1994, 9: 153–165.
Murray PR: Microscopic and bacteriological analysis of expectorated sputum. Mayo Clinic Proceedings 1975, 50: 339–344.
Yu VL:Legionella pneumophila (Legionnaires' disease). In: Mandell GL, Bennet JE, Dolin R (ed): Principles and practice of infectious diseases. Churchill Livingstone, New York 1995, p. 2087–2097.
Schlossberg D:Chlamydia psittaci (psittacosis). In: Mandell GL, Bennet JE, Dolin R (ed): Principles and practice of infectious diseases. Churchill Livingstone, New York 1995, p. 1693–1696.
Grayston TJ:Chlamydia pneumoniae. In: Mandell GL, Bennet JE, Dolin R (ed): Principles and practice of Infectious diseases. Churchill Livingstone, New York 1995, p. 1696–1701.
Venkatesan P, Gladman J, Macfarlane JT, Barer D, Berman P, Kinnear W, Finch RG: A hospital study of community-acquired pneumonia in the elderly. Thorax 1990, 45: 254–258.
Örtqvist A, Grepe A, Julander I, Kalin M: Bacteremic pneumococcal pneumonia in Sweden: clinical course and outcome and comparison with non-bacteremic pneumococcal and mycoplasmal pneumonias. Scandinavian Journal of Infectious Diseases 1988, 20: 163–171.
Macfarlane JT, Miller AC, Roderick Smit WH, Morris AH, Rose DH: Comparative radiographic features of community acquired Legionnaires' disease, pneumococcal pneumonia, mycoplasma pneumonia, and psittacossis. Thorax 1984, 39: 28–33.
Farr BM, Kaiser DL, Harrison BOW, Connolly CK: Prediction of microbial etiology at admission to hospital for pneumonia from the presenting clinical features. Thorax 1989, 44: 1031–1035.
Helms CM, Viner JP, Sturm RH, Renner RD, Johnson W: Comparative features of pneumococcal, mycoplasmal, and Legionnaires' disease pneumonia. Annals of Internal Medicine 1979, 90: 543–547.
Tew J, Calenoff L, Berlin BS: Bacterial or nonbacterial pneumonia: accuracy of radiographic diagnosis. Radiology 1977, 124: 607–612.
Kalin M, Grandien M: Rapid diagnostic methods in respiratory infections. Current Opinion in Infectious Diseases 1993, 6: 150–157.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bohte, R., Hermans, J. & van den Broek, P.J. Early recognition ofStreptococcus pneumoniae in patients with community-acquired pneumonia. Eur. J. Clin. Microbiol. Infect. Dis. 15, 201–205 (1996). https://doi.org/10.1007/BF01591354
Issue Date:
DOI: https://doi.org/10.1007/BF01591354