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. 2000 Feb;55(2):133–137. doi: 10.1136/thorax.55.2.133

Diagnosis of pneumococcal pneumonia by polymerase chain reaction (PCR) in whole blood: a prospective clinical study

M Lorente 1, M Falguera 1, A Nogues 1, A Gonzalez 1, M Merino 1, M Caballero 1
PMCID: PMC1745670  PMID: 10639531

Abstract

BACKGROUND—Streptococcus pneumoniae is the leading cause of community acquired pneumonia; however, only a small proportion of cases can be detected by conventional methods. The ability of the polymerase chain reaction (PCR) test performed on whole blood samples to identify patients with pneumococcal pneumonia was investigated.
METHODS—One hundred and fourteen consecutive adult patients with community acquired pneumonia were evaluated by a wide battery of diagnostic tests in order to determine the aetiology. Blood samples from these patients and 50 controls were also tested by the nested PCR test to detect selected pneumolysin gene fragments of S pneumoniae.
RESULTS—The patients were divided into four groups: (1) 40 patients with pneumococcal pneumonia in 22 of whom (55%) the PCR was positive (eight of 11 with bacteraemia and 14 of 29 without); (2) 30 with pneumonia due to other pathogens in all of whom the PCR was negative; (3) 44 with pneumonia of unknown aetiology in 14 of whom (32%) PCR was positive, and (4) 50 controls in whom the PCR test was positive in two (4%). Thus, the sensitivity of the test was 55% and the specificity 100% (81% if positive PCR tests among undiagnosed patients are considered as false positive results).
CONCLUSION—PCR applied to whole blood samples appears to be a sensitive and very specific diagnostic test for identifying patients with pneumococcal pneumonia with a potential application in clinical practice.



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Selected References

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  1. Bates J. H., Campbell G. D., Barron A. L., McCracken G. A., Morgan P. N., Moses E. B., Davis C. M. Microbial etiology of acute pneumonia in hospitalized patients. Chest. 1992 Apr;101(4):1005–1012. doi: 10.1378/chest.101.4.1005. [DOI] [PubMed] [Google Scholar]
  2. Bohte R., Hermans J., van den Broek P. J. Early recognition of Streptococcus pneumoniae in patients with community-acquired pneumonia. Eur J Clin Microbiol Infect Dis. 1996 Mar;15(3):201–205. doi: 10.1007/BF01591354. [DOI] [PubMed] [Google Scholar]
  3. Dagan R., Shriker O., Hazan I., Leibovitz E., Greenberg D., Schlaeffer F., Levy R. Prospective study to determine clinical relevance of detection of pneumococcal DNA in sera of children by PCR. J Clin Microbiol. 1998 Mar;36(3):669–673. doi: 10.1128/jcm.36.3.669-673.1998. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Dorca J., Manresa F., Esteban L., Barreiro B., Prats E., Ariza J., Verdaguer R., Gudiol F. Efficacy, safety, and therapeutic relevance of transthoracic aspiration with ultrathin needle in nonventilated nosocomial pneumonia. Am J Respir Crit Care Med. 1995 May;151(5):1491–1496. doi: 10.1164/ajrccm.151.5.7735605. [DOI] [PubMed] [Google Scholar]
  5. Falguera M., Nogues A., Ruiz-González A., García M., Puig T., Rubio-Caballero M. Transthoracic needle aspiration in the study of pulmonary infections in patients with HIV. Chest. 1994 Sep;106(3):697–702. doi: 10.1378/chest.106.3.697. [DOI] [PubMed] [Google Scholar]
  6. Farr B. M., Kaiser D. L., Harrison B. D., Connolly C. K. Prediction of microbial aetiology at admission to hospital for pneumonia from the presenting clinical features. British Thoracic Society Pneumonia Research Subcommittee. Thorax. 1989 Dec;44(12):1031–1035. doi: 10.1136/thx.44.12.1031. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Ieven M., Goossens H. Relevance of nucleic acid amplification techniques for diagnosis of respiratory tract infections in the clinical laboratory. Clin Microbiol Rev. 1997 Apr;10(2):242–256. doi: 10.1128/cmr.10.2.242. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Isaacman D. J., Zhang Y., Reynolds E. A., Ehrlich G. D. Accuracy of a polymerase chain reaction-based assay for detection of pneumococcal bacteremia in children. Pediatrics. 1998 May;101(5):813–816. doi: 10.1542/peds.101.5.813. [DOI] [PubMed] [Google Scholar]
  9. Isaacman D. J., Zhang Y., Rydquist-White J., Wadowsky R. M., Post J. C., Ehrlich G. D. Identification of a patient with Streptococcus pneumoniae bacteremia and meningitis by the polymerase chain reaction (PCR). Mol Cell Probes. 1995 Jun;9(3):157–160. doi: 10.1006/mcpr.1995.0026. [DOI] [PubMed] [Google Scholar]
  10. Kwok S., Higuchi R. Avoiding false positives with PCR. Nature. 1989 May 18;339(6221):237–238. doi: 10.1038/339237a0. [DOI] [PubMed] [Google Scholar]
  11. Liederman E. M., Post J. C., Aul J. J., Sirko D. A., White G. J., Buchman C. A., Ehrlich G. D. Analysis of adult otitis media: polymerase chain reaction versus culture for bacteria and viruses. Ann Otol Rhinol Laryngol. 1998 Jan;107(1):10–16. doi: 10.1177/000348949810700103. [DOI] [PubMed] [Google Scholar]
  12. Macfarlane J. T., Finch R. G., Ward M. J., Macrae A. D. Hospital study of adult community-acquired pneumonia. Lancet. 1982 Jul 31;2(8292):255–258. doi: 10.1016/s0140-6736(82)90334-8. [DOI] [PubMed] [Google Scholar]
  13. Mandell L. A. Community-acquired pneumonia. Etiology, epidemiology, and treatment. Chest. 1995 Aug;108(2 Suppl):35S–42S. doi: 10.1378/chest.108.2_supplement.35s. [DOI] [PubMed] [Google Scholar]
  14. Reimer L. G., Carroll K. C. Role of the microbiology laboratory in the diagnosis of lower respiratory tract infections. Clin Infect Dis. 1998 Mar;26(3):742–748. doi: 10.1086/514583. [DOI] [PubMed] [Google Scholar]
  15. Rudolph K. M., Parkinson A. J., Black C. M., Mayer L. W. Evaluation of polymerase chain reaction for diagnosis of pneumococcal pneumonia. J Clin Microbiol. 1993 Oct;31(10):2661–2666. doi: 10.1128/jcm.31.10.2661-2666.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Ruiz-González A., Nogués A., Falguera M., Porcel J. M., Huelin E., Rubio-Caballero M. Rapid detection of pneumococcal antigen in lung aspirates: comparison with culture and PCR technique. Respir Med. 1997 Apr;91(4):201–206. doi: 10.1016/s0954-6111(97)90039-1. [DOI] [PubMed] [Google Scholar]
  17. Salo P., Ortqvist A., Leinonen M. Diagnosis of bacteremic pneumococcal pneumonia by amplification of pneumolysin gene fragment in serum. J Infect Dis. 1995 Feb;171(2):479–482. doi: 10.1093/infdis/171.2.479. [DOI] [PubMed] [Google Scholar]
  18. Torres J. M., Cardenas O., Vasquez A., Schlossberg D. Streptococcus pneumoniae bacteremia in a community hospital. Chest. 1998 Feb;113(2):387–390. doi: 10.1378/chest.113.2.387. [DOI] [PubMed] [Google Scholar]
  19. Walker J. A., Allen R. L., Falmagne P., Johnson M. K., Boulnois G. J. Molecular cloning, characterization, and complete nucleotide sequence of the gene for pneumolysin, the sulfhydryl-activated toxin of Streptococcus pneumoniae. Infect Immun. 1987 May;55(5):1184–1189. doi: 10.1128/iai.55.5.1184-1189.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Watanakunakorn C., Bailey T. A. Adult bacteremic pneumococcal pneumonia in a community teaching hospital, 1992-1996. A detailed analysis of 108 cases. Arch Intern Med. 1997 Sep 22;157(17):1965–1971. [PubMed] [Google Scholar]
  21. Zhang Y., Isaacman D. J., Wadowsky R. M., Rydquist-White J., Post J. C., Ehrlich G. D. Detection of Streptococcus pneumoniae in whole blood by PCR. J Clin Microbiol. 1995 Mar;33(3):596–601. doi: 10.1128/jcm.33.3.596-601.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]

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