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Lu Y, Joseph L, Bélisle P, Sawatwong P, Jatapai A, Whistler T, Thamthitiwat S, Paveenkittiporn W, Khemla S, Van Beneden CA, Baggett HC, Gregory CJ. Pneumococcal pneumonia prevalence among adults with severe acute respiratory illness in Thailand - comparison of Bayesian latent class modeling and conventional analysis. BMC Infect Dis 2019; 19:423. [PMID: 31092207 PMCID: PMC6521483 DOI: 10.1186/s12879-019-4067-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 05/07/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Determining the etiology of pneumonia is essential to guide public health interventions. Diagnostic test results, including from polymerase chain reaction (PCR) assays of upper respiratory tract specimens, have been used to estimate prevalence of pneumococcal pneumonia. However limitations in test sensitivity and specificity and the specimen types available make establishing a definitive diagnosis challenging. Prevalence estimates for pneumococcal pneumonia could be biased in the absence of a true gold standard reference test for detecting Streptococcus pneumoniae. METHODS We conducted a case control study to identify etiologies of community acquired pneumonia (CAP) from April 2014 through August 2015 in Thailand. We estimated the prevalence of pneumococcal pneumonia among adults hospitalized for CAP using Bayesian latent class models (BLCMs) incorporating results of real-time polymerase chain reaction (qPCR) testing of upper respiratory tract specimens and a urine antigen test (UAT) from cases and controls. We compared the prevalence estimate to conventional analyses using only UAT as a reference test. RESULTS The estimated prevalence of pneumococcal pneumonia was 8% (95% CI: 5-11%) by conventional analyses. By BLCM, we estimated the prevalence to be 10% (95% CrI: 7-16%) using binary qPCR and UAT results, and 11% (95% CrI: 7-17%) using binary UAT results and qPCR cycle threshold (Ct) values. CONCLUSIONS BLCM suggests a > 25% higher prevalence of pneumococcal pneumonia than estimated by a conventional approach assuming UAT as a gold standard reference test. Higher quantities of pneumococcal DNA in the upper respiratory tract were associated with pneumococcal pneumonia in adults but the addition of a second specific pneumococcal test was required to accurately estimate disease status and prevalence. By incorporating the inherent uncertainty of diagnostic tests, BLCM can obtain more reliable estimates of disease status and improve understanding of underlying etiology.
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Affiliation(s)
- Ying Lu
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
| | - Lawrence Joseph
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Patrick Bélisle
- Centre Hospitalier de l'Universite de Montreal,Montreal, Montreal, Canada
| | - Pongpun Sawatwong
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Anchalee Jatapai
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.,Office of Public Health, Regional Development Mission for Asia, US Agency for International Development, Bangkok, Thailand
| | - Toni Whistler
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Somsak Thamthitiwat
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Wantana Paveenkittiporn
- Department of Medical Sciences, Ministry of Public Health, National Institute of Health, Nonthaburi, Thailand
| | - Supphacoke Khemla
- Nakhon Phanom Provincial Hospital, Ministry of Public Health, Nakhon Phanom, Thailand
| | - Chris A Van Beneden
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Disease, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Henry C Baggett
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christopher J Gregory
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.,Present affiliation: Division of Vector-Borne Diseases, US Centers for Disease Control and Prevention, Fort Collins, CO, USA
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Hase R, Miyoshi K, Matsuura Y, Endo Y, Nakamura M, Otsuka Y. Legionella pneumonia appeared during hospitalization in a patient with hematological malignancy confirmed by sputum culture after negative urine antigen test. J Infect Chemother 2018; 24:579-582. [PMID: 29373263 DOI: 10.1016/j.jiac.2017.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/20/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Abstract
Legionella pneumophila is recognized as a common causative organism for community-acquired pneumonia, but it is rarely a causative organism for hospital-acquired pneumonia, except in cases of hospital outbreak. Recently, most of the Legionella cases have been diagnosed using the urine antigen test. However, this test can reliably detect only L. pneumophila serogroup 1. Here we report a 63-year-old male patient who was recently diagnosed with acute leukemia and treated with chemotherapy and who developed pneumonia on hospital day 8 during the nadir phase. He was later diagnosed with Legionella pneumonia by culture despite a negative urine antigen test. This case suggests that Legionella pneumonia is an important differential diagnosis for pneumonia in inpatients in the early phase of hospitalization and that when Legionella infection is clinically suspected, culture using selective media or molecular tests should be performed even if the urine antigen test is negative.
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Affiliation(s)
- Ryota Hase
- Department of Infectious Diseases, Japanese Red Cross Narita Hospital, 90-1 Iidacho, Narita, Chiba, Japan.
| | - Kazuyasu Miyoshi
- Department of Infectious Diseases, Japanese Red Cross Narita Hospital, 90-1 Iidacho, Narita, Chiba, Japan
| | - Yasuhiro Matsuura
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, 90-1 Iidacho, Narita, Chiba, Japan
| | - Yasunobu Endo
- Department of Laboratory Medicine, Japanese Red Cross Narita Hospital, 90-1 Iidacho, Narita, Chiba, Japan
| | - Masaki Nakamura
- Division of Bacteriology, Chiba Prefectural Institute of Public Health, 666-2 Nitonacho, Chiba Chuo-ku, Chiba, Japan
| | - Yoshihito Otsuka
- Department of Laboratory Medicine, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba, Japan
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Harris AM, Beekmann SE, Polgreen PM, Moore MR. Rapid urine antigen testing for Streptococcus pneumoniae in adults with community-acquired pneumonia: clinical use and barriers. Diagn Microbiol Infect Dis 2014; 79:454-7. [PMID: 24938760 DOI: 10.1016/j.diagmicrobio.2014.05.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/08/2014] [Accepted: 05/10/2014] [Indexed: 10/25/2022]
Abstract
Streptococcus pneumoniae (pneumococcus) is the most common bacterial etiology of community-acquired pneumonia (CAP) in adults, a leading cause of death. The majority of pneumococcal CAP is diagnosed by blood culture, which likely underestimates the burden of disease. The 2007 CAP guidelines recommend routine use of the rapid pneumococcal urinary antigen (UAg) test. To assess the how pneumococcal UAg testing is being used among hospitalized adult CAP patients and what barriers restrict its use, a Web-based survey was distributed in 2013 to 1287 infectious disease physician members of the Emerging Infectious disease Network of the Infectious Disease Society of America. Of 493 eligible responses, 65% use the pneumococcal UAg test. The primary barrier to UAg use was availability (46%). UAg users reported ordering fewer other diagnostic tests and tailoring antibiotic therapy. Increased access to UAg tests could improve pneumonia management and pneumococcal CAP surveillance.
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Affiliation(s)
- Aaron M Harris
- Respiratory Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | | | | | - Matthew R Moore
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
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