Source: Annual Congress 2001 - Community-acquired pneumonia: from diagnosis to discharge
Disease area: Respiratory infections

Abstract

The epidemiology of LRTi is poorly understood as most studies fail to detect organisms in 50% of cases. PCR is both sensitive and specific and could increase the diagnostic yield if used to detect common respiratory pathogens.
We developed PCR assays to detect S.pneumoniae from the sputum and M.pneumoniae, C.pneumoniae and Legionella species from the throat swabs of adult patients with acute community-acquired LRTi in primary care in addition to standard sputum culture. An acute community-acquired LRTi was defined as: an acute cough present for [lte]21 days associated with at least one other lower respiratory tract symptom for which there was no other explanation (Macfarlane J, Holmes W,Gard P, et al.Thorax 2001;56:109-14.).
135 adults {M=52(38%)/F=83(62%), age(mean±]SD)=48±]18} presenting to their general practitioner's were recruited. Sputum{90/135 (66.7%)} and throat swabs{135(100%)} were obtained before antibiotic treatment. Sputum culture identified 17 pathogens (H.influenzae x13, S.pneumoniae x1, M.catarrhalis x1, Enterobacter x1, Pasturella x1). Sputum PCR detected 8 x S.pneumoniae (pneumolysin gene). Throat swab PCR detected 2 x M.pneumoniae (16sRNA gene),with no C.pneumoniae or Legionella species being detected.
H.influenzae was the commonest pathogen detected (9.6%) followed by S.pneumoniae (6.6%). S.pneumoniae yield increased with PCR. In this population the [dsquote]atypical[dsquote] pathogens were an uncommon cause of LRTi.
We have demonstrated that PCR may improve the detection of pathogens in the investigation of LRTi. Optimisation of PCR assays and specimen selection may further enhance detection.

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Citations should be made in the following way:
D. D. Creer, C. L. Ling, S. Patel, T. D. McHugh, P. Wallace, S. H. Gillespie, J. P. Dilworth (London, United Kingdom). Does polymerase chain reaction (PCR) increase diagnostic yield in the investigation of community-acquired lower respiratory tract illness (LRTI)?. Eur Respir J 2001; 16: Suppl. 31, 3391

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