Bacteremic Pneumococcal Pneumonia Research Articles

Bacteremic pneumococcal pneumonia

Bacteremic pneumococcal pneumonia

Bacteremic Pneumococcal Pneumonia in the Elderly

Pneumococcal pneumonia is an increasingly important disorder of the elderly. We reviewed, retrospectively, the clinical and laboratory manifestations of 29 elderly patients with bacteremic pneumococcal pneumonia during a five year period and surveyed the capsular serotypes of all blood isolates. Pneumococcal pneumonia frequently presented with subtle manifestations in these elderly patients: 50% lacked historical features suggestive of pneumonia at the time of diagnosis. A common presentation was fever, altered mental status and dehydration. Recognizing this will allow earlier diagnosis and initiation of therapy. Sixty percent of patients had potential pulmonary pathogens other than pneumococcus in cultures of sputum at the time of pneumococcal bacteremia. Reversible abnormalities of liver function were frequent. Sixty-nine percent of pneumonias were caused by serotypes included in the commercially available vaccine. Continued surveillance of pneumococcal serotypes is important to determine if the widespread use of the vaccine will result in an increased incidence of infection by serotypes which are not in the vaccine. The high mortality associated with pneumococcal pneumonia (31% in this series), particularly in the elderly, emphasizes the need for an effective vaccine.

Community-Acquired Bacteremic Pneumococcal Pneumonia

The cases of 38 hospitalized adults with community-acquired bacteremic pneumococcal pneumonia were evaluated prospectively to identify age-related differences in presenting features, clinical course, and outcome. Ten of 18 elderly patients (older than 65 years) were admitted from chronic care institutions v one of 20 younger adults. Coronary artery disease was more prevalent among the aged patients, and alcohol abuse and cigarette smoking were more common among the younger patients. All of the elderly persons and 90% of the younger had at least one serious underlying disorder. Older patients tended to report rigors and pleuritic chest pain less frequently than did the younger. Azotemia and roentgenographic evidence of multiple-lobe involvement were found more commonly in elderly persons. However, age-associated discrepancies were not observed in the duration of symptoms before admission, the prevalence of respiratory failure or metastatic infection, the interval between presentation and antibiotic administration, the duration of fever, the length of hospitalization, or the case fatality rates. Thus, the effects of advanced age on the manifestations and clinical course of community-acquired bacteremic pneumococcal pneumonia appear less pronounced than has been reported previously.

Community-acquired bacteremic pneumococcal pneumonia. Effect of age on manifestations and outcome

Community-acquired bacteremic pneumococcal pneumonia. Effect of age on manifestations and outcome

Pneumococcal Vaccine for the `Healthy Elderly'?-Reply

In Reply.— Since the incidence and case fatality rates of pneumococcal disease are high in persons 50 years of age or older (the elderly), they should receive pneumococcal polysaccharide vaccine.1,2In our study of pneumococcal disease in Huntington, WVa, and environs, this age group had an annual incidence for total pneumococcal disease of 40 to 125 per 100,000.1One in four elderly persons with bacteremic pneumococcal pneumonia died and four in five with extrapulmonary pneumococcal disease died. Other physicians have reported similar results.1 Since most elderly persons have underlying diseases that place them at increased risk of serious pneumococcal disease, they usually constitute the largest group of persons tested in any study of pneumonia among adults. The data unequivocally support their being immunized with pneumococcal vaccine as a sound approach to preventing pneumococcal disease.3 Persons 50 years of age or older who do not have overt

Bacteremic pneumococcal pneumonia: Value of culture of nasopharyngeal specimens and examination of washed sputum specimens

Bacteremic pneumococcal pneumonia: Value of culture of nasopharyngeal specimens and examination of washed sputum specimens

An Outbreak of Type 1 Pneumococcal Pneumonia in a Men's Shelter

A striking increase in blood culture isolates of Streptococcus pneumonia capsular type 1 was noted at Boston City Hospital in early 1978. The increased incidence of type 1 pneumococcal bacteremia was due, at least in part, to an outbreak of disease among alcoholic, male clients of Boston's largest shelter. Residents of the shelter also were found to have a high rate of nose and throat carriage of type 1 pneumococci. This outbreak of bacteremic pneumococcal pneumonia is compared with endemic disease caused by other serotypes observed at Boston City Hospital during the same period and with previous studies of epidemic pneumococcal disease. Routine serotyping of pneumococcal isolates is important, especially in light of the emergence of pneumococci resistant to multiple antibiotics and of the renewed use of polysaccharide vaccines.

Evaluation of a hemolytic assay of the alternative complement pathway in human serum.

Alternative pathway activity of human serum was titrated by use of unsensitized rabbit erythrocytes (RE). Under the conditions of the assay, the von Krogh equation could be used to relate the proportion of RE lysed to the level of alternative pathway activity. The use of a 50% hemolytic endpoint provided maximum sensitivity in the assay. The 50% hemolytic endpoint could be calculated from a single measurement in the region of 20% to 80% lysis or RE. Factor B was required for lysis of RE in the test, but neither C2 nor C8 was limiting under the conditions of the assay. Alternative pathway activities of three sera with abnormal IgG levels were in the normal range, but normal serum absorbed with RE at 0 C before testing had diminished lytic activity with the test. Lysis of RE in acute-phase sera of 16 patients who had bacteremic pneumococcal pneumonia was significantly below normal (P < 0.01). Results with Re lysis in these patients correlated well with levels of Factor B that were measured immunochemically and with consumption of whole complement by zymosan.

Value of sputum culture in diagnosis of pneumococcal pneumonia.

In our laboratory, culture of sputum was extremely useful in diagnosing the etiology of pneumococcal pneumonia. Of 31 consecutive patients with bacteremic pneumococcal pneumonia, 29 (94%) had Streptococcus pneumoniae cultured from sputum. Recovery of pneumococci in culture was enhanced by anaerobic incubation as well as by a plate bile test and an optochin disk on a primary blood agar plate.

Prospectus: the prevention of bacteremic pneumococcal pneumonia. A conservative appraisal of vaccine intervention

Prospectus: the prevention of bacteremic pneumococcal pneumonia. A conservative appraisal of vaccine intervention

Prospectus: The Prevention of Bacteremic Pneumococcal Pneumonia

Blood, cerebrospinal fluid, and respiratory isolates from 632 adults with pneumococcal pneumonia hospitalized from 1968 through 1972 were typed. The results were correlated with the 14 types currently being tested in pneumococcal vaccines. More than 80% of the bacteremic pneumonia isolates and two thirds of respiratory isolates were "vaccine types." Sixty percent of 43 patients with bacteremic pneumonia and 55% of patients who died from their infections would theoretically have benefited from an immunization program designed to include all persons 50 years of age and older and all younger patients with recognized underlying disease. Unexplained swings in the annual rate of pneumococcal infections, siteto-site variation in the recovery of pneumococcal types, geographic and temporal differences in the distribution of types, and the selection pressure associated with the use of a limited number of vaccine types will complicate vaccine use. (<i>JAMA</i>230:404-408, 1974)

Capsular Types and Outcome of Bacteremic Pneumococcal Disease in the Antibiotic Era

Between October 1967 and February 1970, a total of 325 adults with bacteremic pneumococcal disease or an extrapulmonary focus or both were admitted to the Cook County Hospital and were investigated for infecting pneumococcal capsular type and outcome of the disease. Of these, 262 (81%) patients had bacteremic pneumococcal pneumonia only and 63 (19%) had an extrapulmonary focus of infection with or without pneumonia. Eight capsular types, numbers 8, 4, 5, 12, 3, 1, 7, and 9 in decreasing frequency, accounted for two thirds of the infections. No one pneumococcal type predominated. The overall case fatality rate, irrespective of type or antibiotic treatment, was 28%. All patients received treatment with antibiotics, usually penicillin, tetracycline, or erythromycin, alone or together with other antibiotics. Deaths were more frequent in older patients, and in patients with an extrapulmonary focus of infection or complicating chronic disease. These findings point up the unchanged high case fatality rate from bacteremic pneumococcal infection. For the control of pneumococcal disease, a polyvalent pneumococcal polysaccharide vaccine would have broad application, especially among high-risk groups.