Purulent pericarditis due to Streptococcus pneumoniae diagnosed by pneumococcal urinary antigen assay and 16S rDNA sequence of the pericardial fluid.

Intern Med. 2010;49(15):1653-6.

Nakagawa C, Kasahara K, Yonekawa S, Ogawa T, Kutsuna S, Maeda K, Konishi M, Kikuchi K, Mikasa K.

Source

Center for Infectious Diseases, Nara Medical University, Kashihara.

Abstract

A 57-year old woman was admitted to our hospital with massive pericardial fluid. Culture of the pericardial fluid was negative, however, Binax NOW Streptococcus pneumoniae urinary antigen test was positive in pericardial fluid. 16S rDNA sequencing and PCR for lyt(A) gene of the pericardial fluid sample confirmed the microbiological diagnosis of S. pneumoniae. The patient was treated with surgical drainage and continuous intravenous infusion of penicillin G and its concentration in the serum and pericardial effusion was monitored. Incorporation of molecular methods such as antigen testing and nucleic acid sequencing would benefit the management of infectious diseases especially in culture negative cases.

PDF

https://www.jstage.jst.go.jp/article/internalmedicine/49/15/49_15_1653/_pdf

Impact of bacteremia in a cohort of patients with pneumococcal pneumonia.

J Bras Pneumol. 2012 Jul-Aug;38(4):422-30.

Palma I, Mosquera R, Demier C, Vay CA, Famiglietti A, Luna CM.

Source

División de Neumología, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina.

Abstract

OBJECTIVE:

Bacteremia is the most common presentation of invasive disease in community-acquired pneumonia (CAP) due to Streptococcus pneumoniae. We investigated whether bacteremia in pneumococcal CAP worsens outcomes and whether it is related to pneumococcal vaccination (PV).

METHODS:

Secondary analysis of a cohort of patients with pneumococcal CAP confirmed by blood culture, sputum culture, or urinary antigen testing. Demographic, clinical, radiographic, and biochemical data were collected, as were Acute Physiology and Chronic Health Evaluation II (APACHE II) and pneumonia severity index (PSI) scores, comorbidities, and PV history. We drew comparisons between patients with bacteremic pneumococcal CAP (BPP) and those with non-bacteremic pneumococcal CAP (NBPP).

RESULTS:

Forty-seven patients had BPP, and 71 had NBPP (confirmed by sputum culture in 45 and by urinary antigen testing in 26); 107 had some indication for PV. None of the BPP patients had received PV, compared with 9 of the NBPP patients (p = 0.043). Among the BPP patients, the mean age was higher (76.4 ± 11.5 vs. 67.5 ± 20.9 years), as were APACHE II and PSI scores (16.4 ± 4.6 vs. 14.1 ± 6.5 and 129.5 ± 36 vs. 105.2 ± 45, respectively), as well as the rate of ICU admission for cardiopathy or chronic renal failure (42.5% vs. 22.5%), whereas hematocrit and plasma sodium levels were lower (35.7 ± 5.8 vs. 38.6 ± 6.7% and 133.9 ± 6.0 vs. 137.1 ± 5.5 mEq/L, respectively), although mortality was similar (29.8% vs. 28.2%).

CONCLUSIONS:

In this population at high risk for CAP due to S. pneumoniae, the PV rate was extremely low (8.4%). Although BPP patients were more severely ill, mortality was similar between the two groups. Because PV reduces the incidence of BPP, the vaccination rate in at-risk populations should be increased.

PDF

http://www.scielo.br/pdf/jbpneu/v38n4/en_v38n4a03.pdf

Clinical implications of pneumococcal serotypes: invasive disease potential, clinical presentations, and antibiotic resistance.

J Korean Med Sci. 2013 Jan;28(1):4-15.

Song JY, Nahm MH, Moseley MA.

Source

Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea. infection@korea.ac.kr

Abstract

Streptococcus pneumoniae can asymptomatically colonize the nasopharynx and cause a diverse range of illnesses. This clinical spectrum from colonization to invasive pneumococcal disease (IPD) appears to depend on the pneumococcal capsular serotype rather than the genetic background. According to a literature review, serotypes 1, 4, 5, 7F, 8, 12F, 14, 18C, and 19A are more likely to cause IPD. Although serotypes 1 and 19A are the predominant causes of invasive pneumococcal pneumonia, serotype 14 remains one of the most common etiologic agents of non-bacteremic pneumonia in adults, even after 7-valent pneumococcal conjugate vaccine (PCV7) introduction. Serotypes 1, 3, and 19A pneumococci are likely to cause empyema and hemolytic uremic syndrome. Serotype 1 pneumococcal meningitis is prevalent in the African meningitis belt, with a high fatality rate. In contrast to the capsule type, genotype is more closely associated with antibiotic resistance. CC320/271 strains expressing serotype 19A are multidrug-resistant (MDR) and prevalent worldwide in the era of PCV7. Several clones of MDR serotype 6C pneumococci emerged, and a MDR 6D clone (ST282) has been identified in Korea. Since the pneumococcal epidemiology of capsule types varies geographically and temporally, a nationwide serosurveillance system is vital to establishing appropriate vaccination strategies for each country.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3546102/pdf/jkms-28-4.pdf

Estimating the Burden of Pneumococcal Pneumonia among Adults: A Systematic Review and Meta-Analysis of Diagnostic Techniques.

PLoS One. 2013;8(4):e60273.

Said MA, Johnson HL, Nonyane BA, Deloria-Knoll M, O Brien KL; AGEDD Adult Pneumococcal Burden Study Team.

Source

Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.

Abstract

BACKGROUND:

Pneumococcal pneumonia causes significant morbidity and mortality among adults. Given limitations of diagnostic tests for non-bacteremic pneumococcal pneumonia, most studies report the incidence of bacteremic or invasive pneumococcal disease (IPD), and thus, grossly underestimate the pneumococcal pneumonia burden. We aimed to develop a conceptual and quantitative strategy to estimate the non-bacteremic disease burden among adults with community-acquired pneumonia (CAP) using systematic study methods and the availability of a urine antigen assay.

METHODS AND FINDINGS:

We performed a systematic literature review of studies providing information on the relative yield of various diagnostic assays (BinaxNOW® S. pneumoniae urine antigen test (UAT) with blood and/or sputum culture) in diagnosing pneumococcal pneumonia. We estimated the proportion of pneumococcal pneumonia that is bacteremic, the proportion of CAP attributable to pneumococcus, and the additional contribution of the Binax UAT beyond conventional diagnostic techniques, using random effects meta-analytic methods and bootstrapping. We included 35 studies in the analysis, predominantly from developed countries. The estimated proportion of pneumococcal pneumonia that is bacteremic was 24.8% (95% CI: 21.3%, 28.9%). The estimated proportion of CAP attributable to pneumococcus was 27.3% (95% CI: 23.9%, 31.1%). The Binax UAT diagnosed an additional 11.4% (95% CI: 9.6, 13.6%) of CAP beyond conventional techniques. We were limited by the fact that not all patients underwent all diagnostic tests and by the sensitivity and specificity of the diagnostic tests themselves. We address these resulting biases and provide a range of plausible values in order to estimate the burden of pneumococcal pneumonia among adults.

CONCLUSIONS:

Estimating the adult burden of pneumococcal disease from bacteremic pneumococcal pneumonia data alone significantly underestimates the true burden of disease in adults. For every case of bacteremic pneumococcal pneumonia, we estimate that there are at least 3 additional cases of non-bacteremic pneumococcal pneumonia.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3615022/pdf/pone.0060273.pdf

 

Guidelines on the diagnosis and management of pericardial diseases.

Eur Heart J. 2004 Apr;25(7):587-610.

Executive summary. The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology.

Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y, Tomkowski WZ, Thiene G, Yacoub MH; Task Force on the Diagnosis and Management of Pricardial Diseases of the European Society of Cardiology.

Source

Department of Internal Medicine-Cardiology, Philipps University, Marburg, Germany. bermaisch@aol.com

PDF

http://eurheartj.oxfordjournals.org/content/25/7/587.full.pdf+html

 

Comment in

The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version. Destroy user interface controlUtility and safety of diagnostic pericardiocentesis. [Eur Heart J. 2005]

PDF

http://eurheartj.oxfordjournals.org/content/26/10/1046.2.full.pdf+html

Clinical practice. Acute pericarditis.

N Engl J Med. 2004 Nov 18;351(21):2195-202.

Lange RA, Hillis LD.

Source

Department of Internal Medicine, Cardiology Division, Johns Hopkins Medical Institutions, Baltimore, USA.

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMcp041997

 

Erratum in

N Engl J Med. 2005 Mar 17;352(11):1163.

http://www.nejm.org/doi/pdf/10.1056/NEJM200503173521131

Pneumococcal pericarditis since 1980.

Clin Infect Dis. 1998 Nov;27(5):1338-40.

LETTER

Go C, Asnis DS, Saltzman H.

PDF

http://cid.oxfordjournals.org/content/27/5/1338.1.long

Comment on

Clin Infect Dis. 1998 Mar;26(3):762-3.

Saenz RE, Sanders CV, Aldridge KE, Patel MM.

Source

School of Medicine in New Orleans, Louisiana State University, University Medical Center, Lafayette, USA.

The following popper user interface control may not be accessible.  Tab to the next button to revert the control to an accessible version. Destroy user interface control Purulent pericarditis with associated cardiac tamponade caused by a Streptococcus pneumoniae strain highly resistant to penicillin, cefotaxime, and ceftriaxone. [Clin Infect Dis. 1998]

PDF

http://cid.oxfordjournals.org/content/26/3/762.long