Investigation of bacterial infections of the lower respiratory tract

Current Opinion in Infectious Diseases

Volumn 9, Issue 2, 1996, Pages 76-84

  Boersma, Wim G ^a   Holloway, Yvette ^b  

^a Medical Centre Alkmaar   (Netherlands)

^b Research Laboratory   (Netherlands)

Author keywords

[No Author keywords available]

Indexed keywords

BACTERIAL ANTIGEN; BACTERIAL DNA; BACTERIAL RNA;

ANTIGEN DETECTION; BACTERIAL INFECTION; FATALITY; LOWER RESPIRATORY TRACT INFECTION; LUNG LAVAGE; PNEUMONIA; POLYMERASE CHAIN REACTION; REVIEW; SPUTUM EXAMINATION;

EID: 0029986988     PISSN: 09517375     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001432-199604000-00007     Document Type: Review

References (78)

1. Örtqvist A: Initial investigation and treatment of the patient with severe community-acquired pneumonia. Semin Respir Infect 1994, 9:166-179. An excellent review considering different aspects of severe CAP including recommendations for diagnostic investigations and empirical therapy in patients with ICU-requiring pneumonia.
2. American Thoracic Society: Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy. Am Rev Respir Dis 1993, 143:1418-1426.
3. British Thoracic Society: Guidelines for the management of community-acquired pneumonia in adults admitted to hospital. Br J Hosp Med 1993, 49:346-350.
4. Marrie TJ: Community-acquired pneumonia. Clin Infect Dis 1994, 18:501-515.
5. Iredale MJ, Howard MR, Evans SA, Woodhead MA: Blood culture quality in community-acquired pneumonia [Abstract]. Thorax 1994, 49:1067.
6. Mermel LA, Maki DG: Detection of bacteremia in adults: consequences of culturing an inadequate volume of blood. Ann Intern Med 1993, 119:270-272.
7. Claxton PM, Masterton RG: Rapid organism identification from Bactee NR blood culture media in a diagnostic microbiology laboratory. J Clin Pathol 1994, 47:796-798.
8. Venkatesan P, Macfarlane JT: The role of pneumococcal antigen in the diagnosis of pneumococcal pneumonia. Thorax 1992, 47:329-331.
9. Holloway Y, Boersma WG, Kuttschrütter H, Snijder JAM: Minimum number of pneumococci required for capsular antigen to be detectable by latex agglutination. J Clin Microbiol 1992, 30:517-519.
10. Holloway Y, Snijder JAM, Boersma WG: Demonstration of circulating pneumococcal immunoglobulin G immune complexes in patients with community-acquired pneumonia by means of an enzyme- linked immunosorbent assay. J Clin Microbiol 1993, 31:3247-3254.
11. Zhang Y, Isaacman DJ, Wadowsky RM, Rydquist-White J, Post JC, Ehrlich GD: Detection of Streptococcus pneumoniae in whole blood by PCR. J Clin Microbiol 1995, 33:596-601.
12. Rudolph KM, Parkinson AJ, Black CM, Mayer LW: Evaluation of polymerase chain reaction for diagnosis of pneumococcal pneumonia. J Clin Microbiol 1993, 31:2661-2666.
13. Salo P, Örtqvist A, Leinonen M: Diagnosis of bacteremic pneumococcal pneumonia by amplification of pneumolysin gene fragment in serum. J Infect Dis 1995, 171:479-482. All 20 bacteraemic cases with pneumococcal pneumonia had detectable pneumolysin fragments by PCR in their sera. The specificity of the test was 94%.
14. Hassan King M, Baldeh I, Secka O, Falade A, Greenwood B: Detection of Streptococcus pneumoniae DNA in blood cultures by PCR. J Clin Microbiol 1994, 32:1721-1724.
15. Hermans PWM, Sluyter M, Hoogenboezem T, Heersma H, van Belkum A, de Groot R: Comparative study of five different DNA fingerprinting techniques for molecular typing of Streptococcus pneumoniae strains. J Clin Microbiol 1995, 33:1606-1612.
16. Schluger NW, Rom WN: The polymerase chain reaction in the diagnosis and evaluation of pulmonary infections. Am J Respir Crit Care Med 1995, 152:11-16. In this review principles and practice of PCR in the diagnosis and evaluation of lower respiratory tract infections are discussed precisely. The results of several studies detecting P. carinii, Mycoplasma tuberculosis, cytomegalovirus, L. pneumophila and Aspergillus fumigatus with PCR are placed in perspective and a critical note for investigations in the future is made.
17. Leinonen M: Serological diagnosis of pneumococcal pneumonia - will it ever become a clinical reality. Semin Respir Infect 1994, 9:189-191.
18. Christensen JJ, Renneberg J, Bruun B, Forsgren A: Serum antibody response to proteins of Moraxella (Branhamella) catarrhalis in patients with lower respiratory tract infection. Clin Diagn Lab Immunol 1995, 2:14-17. IgG antibodies against M. catarrhalis were present in 71% of 48 patients with M. catarrhalis isolated from lower respiratory tract specimens. Seroconversion was present in eight of these cases. IgM and IgA antibodies were detected in only one patient and none of the patients, respectively.
19. Rahman M, Holme T, Jönsson I, Krook A: Lack of serotype-specific antibody response to lipopolysaccharide antigens of Moraxella catarrhalis during lower respiratory tract infection. Eur J Clin Microbiol Infect Dis 1995, 14:297-304.
20. Sethi S, Hill SL, Murphy TF: Serum antibodies to outer membrane proteins (OMPs) of Moraxella (Branhamella) catarrhalis in patients with bronchiectasis: identification of OMP B1 as an important antigen. Infect Immuno 1995, 63:1516-1520.
21. Musher DM, Kubitschek KR, Crennan J, Baughn R: Pneumonia and acute febrile tracheobronchitis due to Haemophilus influenzae. Ann Intern Med 1983, 99:444-450.
22. Claesson BA, Lagergård T, Trollfors B: Antibody response to outer membrane of noncapsulated Haemophilus influenzae isolated from the nasopharynx of children with pneumonia. Pediatr Infect Dis J 1991, 10:104-108.
23. Edelstein PH: Legionnaires' disease. Clin Infect Dis 1993, 16:741- 747.
24. Jacobs E: Serological diagnosis of Mycoplasma pneumoniae infections: a critical review of current procedures. Clin Infect Dis 1993, 17(suppl 1):S79-S82.
25. Thacker WI, Talkington DF: Comparison of two rapid commercial tests with complement fixation for serologic diagnosis of Mycoplasme pneumoniae infections. J Clin Microbiol 1995, 33:1212-1214. From this study it was concluded that two commercial tests detecting simultaneously IgG and IgM antibodies against M. pneumoniae were faster and less technically demanding to perform than is the complement fixation test.
26. Marrie TJ: Chlamydia pneumoniae. Thorax 1993, 48:1-4.
27. Wong KH, Skelton SK, Daugharty H: Utility of complement fixation and microimmunofluorescence assays for detecting serologic responses in patients with clinically diagnosed psittacosis. J Clin Microbiol 1994, 32:2417-2421. Microimmunofluorescence detected antibody responses to C. psittaci in 48 (62%) of 78 patients, whereas complement fixation was positive in 36 (46%) cases. C. pneumoniae infection was demonstrated in seven (9%) patients with clinically diagnosed psittacosis.
28. Johnson AL, Hampson DF, Hampson NB: Outpatient sputum color: is it predictive of Gram stain or culture results? [Abstract] Am J Respir Crit Care Med 1995, 151:A792.
29. el Ebiary M, Torres A, Gonzalez J, Martos A, Puig de la Bellacasa J, Ferrer M, Rodriguez Roisin R: Use of elastin fibre detection in the diagnosis of ventilator associated pneumonia. Thorax 1995, 50:14-17. The detection of elastin fibres in respiratory specimens of patients suspected of ventilator-associated pneumonia had a sensitivity of 32% and specificity of 72%. When P. aeruginosa and other Gram negative bacteria were considered, the sensitivity increased to 44% and 43%, respectively, whereas the specificity was 81% and 86%.
30. Sole Violan J, Rodriguez de Castro F, Rey A, Martin Gonzalez JC, Cabrera Navarro P: Usefulness of microscopic examination of intracellular organisms in lavage fluid in ventilator-associated pneumonia. Chest 1994, 106:889-894.
31. Deulofeu F, Nava JM, Bella F, Marti C, Morera MA, Font B, Fontanals D, Lite J, Garau J, Calderon A et al.: Prospective epidemiological study of invasive Haemophilus influenzae disease in adults. Eur J Clin Microbiol Infect Dis 1994, 13:633-638.
32. Ioannidis JPA, Worthington M, Griffiths JK, Snydman DR: Spectrum and significance of bacteremia due to Moraxella catarrhalis. Clin Infect Dis 1995, 21:390-397. From the 58 cases with bacteraemia caused by M. catarrhalis half of the patients had an associated respiratory tract infection. Most of the patients had a respiratory predisposing factor or underlying malignancy or neutropenia or both. Only 28% had no predisposing factor. The overall mortality was 21%.
33. Bartlett JG: Anaerobic bacterial infections of the lung and pleural space. Clin Infect Dis 1993, 16(suppl 4):S248-S255.
34. Boersma WG, Löwenberg A, Holloway Y, Kuttschrütter H, Snijder JAM, Koëter GH: The role of antigen detection in pneumococcal carriers: a comparison between cultures and capsular antigen detection in upper respiratory tract secretions. Scand J Infect Dis 1993, 25:51-56.
35. Venkatesan P, Sole K, Macfarlane JT, Finch RG: Oropharyngeal production of pneumococcal capsular antigen and the potential for contamination of expectorated sputum samples in pneumococcal pneumonia. Epidemiol Infect 1993, 110:621-631.
36. Gillespie SH, Smith MD, Dickens A, Raynes JG, McAdam KP: Diagnosis of Streptococcus pneumoniae pneumonia by quantitative enzyme linked immunosorbent assay of C-polysaccharide antigen. J Clin Pathol 1994, 47:749-751. With the ELISA assay quantitation of PnC in sputum could distinguish between carrier status of oral bacteria which express PnC-like antigens and infection with pneumococci.
37. Sillis M, White P, Caul EO, Paul ID, Treharne JD: The differentiation of Chlamydia species by antigen detection in sputum specimens from patients with community-acquired acute respiratory infections. J Infect 1992, 25(suppl 1):77-86.
38. Marmion BP, Williamson J, Worswick DA, Kok TW, Harris RJ: Experience with newer techniques for the laboratory detection of Mycoplasma pneumoniae infection: Adelaide, 1978-1992. Clin Infect Dis 1993, 17(suppl 1):S90-S99.
39. Gillespie SH, Ullman C, Smith MD, Emery V: Detection of Streptococcus pneumoniae in sputum samples by PCR. J Clin Microbiol 1994, 32:1308-1311. Autolysin PCR seems to be suitable for the detection of pneumococci in sputum from patients with pneumococcal pneumonia. Other pathogens and oropharyngeal flora did not yield positive results.
40. Matsiota Bernard P, Pitsouni E, Legakis N, Nauciel C: Evaluation of commercial amplification kit for detection of Legionella pneumophila in clinical specimens. J Clin Microbiol 1994, 32:1503-1505.
41. Koide M, Saito A: Diagnosis of Legionella pneumophila infection by polymerase chain reaction. Clin Infect Dis 1994, 21:199-201.
42. Tjhie JHML, van Kuppeveld FJH, Roosendaal R, Melchers WJG, Gordijn R, MacLaren DM, Walboomers JMM, Meijer CJLM, van den Brule AJC: Direct PCR enables detection of Mycoplasma pneumoniae in patients with respiratory tract infections. J Clin Microbiol 1994, 32:11-16.
43. Reznikov M, Blackmore TK, Finlay-Jones JJ, Gordon DL: Comparison of nasopharyngeal aspirates and throat swab specimens in a polymerase chain reaction-based test for Mycoplasma pneumoniae. Eur J Clin Microbiol Infect Dis 1995, 14:58-61.
44. Grayston JTA, Aldous MB, Easton A, Wang SP, Kuo CC, Campbell LA, Altman J: Evidence that Chlamydia pneumoniae causes pneumonia and bronchitis. J Infect Dis 1993, 168:1231-1235.
45. Thom DH, Grayston JT, Campbell LA, Kuo CC, Diwan VK, Wang SP: Respiratory infection with Chlamydia pneumoniae in middle-aged and older adult outpatients. Eur J Clin Microbiol Infect Dis 1994, 13:785-792. In only a small percentage of middle-aged and older adults could infection with C. pneumoniae be demonstrated. Acute C. pneumoniae infection was demonstrated with either microimmunofluorescence or PCR in 3% (3/61) of cases with pneumonia, 5% (12/247) of those with bronchitis, 5% (3/61) of those with sinusitis only, and 2% (2/103) of those with pharyngitis only.
46. Gaydos CA, Roblin PM, Hammerslag MR, Hyman CL, Eiden JJ, Schachter J, Quinn TC: Diagnostic utility of PCR-enzyme immunoassay, culture, and serology for detection of Chlamydia pneumoniae in symptomatic and asymptomatic patients. J Clin Microbiol 1994, 32:903-905. PCR-EIA was more sensitive than culture for detecting C. pneumoniae infection and may be a valuable tool for rapid diagnosis of this infection.
47. Gaydos CA, Eiden JJ, Oldach D, Mundy LM, Auwarter P, Warner ML, Vance E, Burton AA, Quinn TE. Diagnosis of Chlamydia pneumoniae infection in patients with community-acquired pneumonia by polymerase chain reaction enzyme immunoassay. Clin Infect Dis 1994, 19:157-160.
48. Malinverni R, Kuo CC, Campbell LA, Lee A, Grayston JT: Effects of two antibiotic regimens on course and persistence of experimental Chlamydia pneumoniae TWAR pneumonitis. Antimicrob Agents Chemother 1995, 39:45-49. C. pneumoniae DNA was frequently detected from lung tissues of mice after a short-term antibiotic treatment, whereas cultures yielded negative results.
49. Georghiou PRL, Doggett AM, Kielhofner MA, Stout JE, Watson DA, Lupski JR, Hamill RJ: Molecular fingerprinting of Legionella species by repetitive element PCR. J Clin Microbiol 1994, 32:2989-2994.
50. Ursi D, van Bever H, Quint W, Goossens H, Niesters HGM: Typing of Mycoplasma pneumoniae by PCR-mediated DNA fingerprinting. J Clin Microbiol 1994, 32:2873-2875.
51. Smith Vaughan HC, Sriprakash KS, Mathews JD, Kemp DJ: Long PCR-ribotyping of nontypeable Haemophilus influenzae. J Clin Microbiol 1995, 33:1192-1195. With this PCR technique fragments of ribosomes of non-typable H. influenzae were detected, which may useful for epidemiological investigations.
52. Østergaard L, Andersen PL: Etiology of community-acquired pneumonia. Evaluation by transtracheal aspiration, blood culture, or serology. Chest 1993, 104:1400-1407.
53. Baselski VS, Wunderink RG: Bronchoscopic diagnosis of pneumonia. Clin Microbiol Rev 1994, 7:533-558. Excellent review discussing all different aspects of the bronchscopic procedures and concomitant microbial investigations in different types of pneumonia.
54. Jiménez P, Saldias F, Meneses M, Silva ME, Wilson MG, Otth L: Diagnostic fiberoptic bronchoscopy in patients with community- acquired pneumonia: comparison between bronchoalveolar lavage and telescoping plugged catheter cultures. Chest 1993, 103:1023-1027.
55. Sörensen J, Forsberg P, Hakanson E, Maller R, Sederholm C, Soren L, Carlsson C: A new diagnostic approach to the patient with severe pneumonia. Scand J Infect Dis 1989, 21:33-41.
56. Örtqvist A, Kalin M, Lejdeborn L, Lundberg B: Diagnostic fiberoptic bronchoscopy and protected brush culture in patients with community-acquired pneumonia. Chest 1990, 97:576-582
57. Jimenez P, Meneses M, Saldias F, Velasquez M: Pneumococcal antigen detection in bronchoalveolar lavage fluid from patients with pneumonia. Thorax 1994, 49:872-874. Antigen was detected by CIE in 50% and by latex agglutination in 54% of cases with pneumococcal pneumonia. In half of the patients with pneumonia of unknown aetiology antigen was present in BAL fluid. None of the patients with pneumonia of other aetiology or controls had detectable antigen in BAL fluid.
58. Jonas D, Rosenbaum A, Weyrich S, Bahkdi S: Enzyme-linked immunoassay for detection of PCR-amplified DNA of legionellae in bronchoalveolar fluid. J Clin Microbiol 1995, 33:1247-1252. All relevant Legionella spp. could be detected by this PCR assay. Of the 256 BAL fluids eight were both culture- and PCR-positive. Six further culture- negative BAL fluids yielded a positive PCR test.
59. Maass M, Dalhoff K: Comparison of sample preparation methods for detection of Chlamydia pneumoniae in bronchoalveolar lavage fluid by PCR. J Clin Microbiol 1994, 32:2616-2619.
60. de Barbeyrac B, Bernet Poggi C, Febrer F, Renaudin H, Dupon M, Bebear C: Detection of Mycoplasma pneumoniae and Mycoplasma genitalium in clinical samples by polymerase chain reaction. Clin Infect Dis 1993, 17(suppl 1):S83-S89.
61. Feinsilver SH, Fein AM, Niederman MS, Schultz DE, Faegenburg DH: Utility of fiberoptic bronchoscopy in nonresolving pneumonia. Chest 1990, 98:1322-1326.
62. Kirtland SH, Winterbauer RH, Dreis DF, Pardoe NE, Springmeyer SC: A clinical profile of chronic bacterial pneumonia. Report of 115 cases. Chest 1994, 106:15-22. Underlying chronic disease was demonstrated in 65% of 115 patients. H. influenzae and α-haemolytic streptococcus were isolated in 68% of the patients, whereas bronchogenic carcinoma was present in 14%.
63. Gibson SP, Weir DC, Burge PS: A prospective audit of the value of fibre optic bronchoscopy in adults admitted with community acquired pneumonia. Respir Med 1993, 87:105-109.
64. Manresa F, Dorca J: Needle aspiration techniques in the diagnosis of pneumonia. Thorax 1991, 46:601-603.
65. Bartlett, JG. Invasive diagnostic techniques in pulmonary infections. In Respiratory infections: diagnosis and management. Edited by Pennington JE. New York: Raven Press, 1994: 73-99.
66. Torres A, Jimenez P, Puig de la Bellacasa J, Celis R, Gonzales J, Gea J: Diagnostic value of nonfluoroscopic percutaneous lung needle aspiration in patients with pneumonia. Chest 1990, 98:840-844.
67. Zalacain R, Llorente JL, Gaztelurrutia L, Pijoan JI, Sobradillo V: Influence of three factors on the diagnostic effectiveness of transthoracic needle aspiration in pneumonia. Chest 1995, 107:96-100.
68. Bella F, Tort J, Morera MA, Espaulella J, Armengol J: Value of bacterial antigen detection in the diagnostic yield of transthoracic needle aspiration in severe community acquired pneumonia. Thorax 1993, 48:1227-1229.
69. Ruiz A, Falguera M, Nogués A, Puig T, Rubio M: Pneumococcal pneumonia: improvement the diagnostic yield by using antigen detection and polymerase chain reaction on samples obtained by lung aspiration [Abstract]. Am J Respir Crit Care Med. 1995, 151:A793.
70. Dunn IJ, Marrie TJ, MacKeen AD, Bhan V, Janigan DT: The value of open lung biopsy in immunocompetent patients with community- acquired pneumonia requiring hospitalization. Chest 1994, 106:23-27. In this retrospective study it was shown that open lung biopsy was rarely necessary in immunocompetent patients with CAP. Only two out of eight biopsies yielded a specific diagnosis.
71. Corley DE, Winterbauer RH, Kirtland S, Hammar S, Dail D, Bolen J, Bauermeister D: Analysis of the gold standard. Reproducibility of the histologic diagnosis of pneumonia on open lung biopsy by a panel of four pathologists. Am J Respir Crit Care Med Abstr 1995, 151:A791.
72. Boersma WG, Löwenberg A, Holloway Y, Kuttschrütter H, Snijder JAM, Koëter GH: Rapid antigen detection of pneumococcal antigen in pleural fluid of patients with community-acquired pneumonia. Thorax 1993, 48:160-162.
73. Light RW: A new classification of parapneumonic effusions and empyema. Chest 1995, 108:299-301. This classification and treatment scheme is extremely useful for those clinicians dealing with these complications of pneumonia.
74. O'Neill KP, Lloyd-Evans N, Campbell H, Forgie IM, Sabally S, Greenwood BM: Latex agglutination test for diagnosing pneumococcal pneumonia in children in developing countries. BMJ 1989, 298:1061-1064.
75. Aguero-Rosenfeld ME, Edelstein PH: Retrospective evaluation of the Du Pont radioimmunoassay kit for detection of Legionella pneumophila serogroup 1 antigenuria in humans. J Clin Microbiol 1988, 26:1775-1778.
76. Sathapatayavongs B, Kohler RB, Wheat J, White A, Winn WC, Jr: Rapid diagnosis of Legionnaires' disease by latex agglutination. Am Rev Respir Dis 1983, 127:559-562.
77. Maiwald MS, Schill M, Stockinger C, Helbig JH, Lück JH, Witzleb W, Sonntag HG: Detection of Legionella DNA in human and guinea pig urine samples by the polymerase chain reaction. Eur J Clin Microbiol Infect Dis 1995, 14:25-33. This study demonstrated that Legionella DNA can be excreted in the urine both of guinea pigs and of humans, and that PCR has a higher sensitivity than enzyme immunoassay for detecting soluble Legionella antigen in urine. However, false-positive reactions were found in 10% of patients with urinary tract infections.
78. Woodhead MA, Arrowsmith J, Chamberlain-Webber R, Wooding S, Williams I: The value of routine microbial investigation in community-acquired pneumonia. Respir Med 1991, 85:313-317.