viral and mycoplasma pneumoniae community acquired pneumonia and novel clinical outcome CORD-Papers-2021-10-25 (Version 1)

Title: Viral and Mycoplasma pneumoniae community-acquired pneumonia and novel clinical outcome evaluation in ambulatory adult patients in China
Abstract: Few studies have addressed the etiology and clinical outcomes of community-acquired pneumonia (CAP) treated in an ambulatory setting. We investigated the etiology by the culture of Mycoplasma pneumoniae, urine antigen testing of Streptococcus pneumoniae and Legionella pneumoniae, and DNA or RNA determination of eight kinds of respiratory virus DNA or RNA. An etiological diagnosis was made in 51.8% of 197 patients. The most common pathogens were M. pneumoniae (29.4%) followed by influenza virus A, parainfluenza virus, adenovirus, human metapneumovirus (9.6%), and S. pneumoniae (4.1%). Patients with mycoplasma infections were younger, less likely to have comorbidities, and less likely to have adequate sputum for gram stain and culture. Patients with viral infections were older and more likely to have poorly defined nodules on chest X-ray (CXR) or computed tomography (CT) scan. Among patients infected with M. pneumoniae, those with quinolones as initial prescriptions had shorter duration of fever after the initiation of antibiotics than patients with -lactams, macrolides, or -lactams + macrolides (p < 0.05). This study suggests that M. pneumoniae and respiratory viruses were the most frequent pathogens found in ambulatory adult CAP patients and quinolones were better than -lactams, macrolides, or -lactams + macrolides in the resolution of fever of M. pneumoniae pneumonia.
Published: 7/11/2010
Journal: Eur J Clin Microbiol Infect Dis
DOI: 10.1007/s10096-010-1003-2
DOI_URL: http://doi.org/10.1007/s10096-010-1003-2
Author Name: Cao, B
Author link: https://covid19-data.nist.gov/pid/rest/local/author/cao_b
Author Name: Ren, L L
Author link: https://covid19-data.nist.gov/pid/rest/local/author/ren_l_l
Author Name: Zhao, F
Author link: https://covid19-data.nist.gov/pid/rest/local/author/zhao_f
Author Name: Gonzalez, R
Author link: https://covid19-data.nist.gov/pid/rest/local/author/gonzalez_r
Author Name: Song, S F
Author link: https://covid19-data.nist.gov/pid/rest/local/author/song_s_f
Author Name: Bai, L
Author link: https://covid19-data.nist.gov/pid/rest/local/author/bai_l
Author Name: Yin, Y D
Author link: https://covid19-data.nist.gov/pid/rest/local/author/yin_y_d
Author Name: Zhang, Y Y
Author link: https://covid19-data.nist.gov/pid/rest/local/author/zhang_y_y
Author Name: Liu, Y M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/liu_y_m
Author Name: Guo, P
Author link: https://covid19-data.nist.gov/pid/rest/local/author/guo_p
Author Name: Zhang, J Z
Author link: https://covid19-data.nist.gov/pid/rest/local/author/zhang_j_z
Author Name: Wang, J W
Author link: https://covid19-data.nist.gov/pid/rest/local/author/wang_j_w
Author Name: Wang, C
Author link: https://covid19-data.nist.gov/pid/rest/local/author/wang_c
sha: 44b2e6659a6c435fbdd69ac1c6a158db72714c7d
license: no-cc
license_url: [no creative commons license associated]
source_x: Medline; PMC
source_x_url: https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 20623362
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/20623362
pmcid: PMC7088295
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7088295
url: https://doi.org/10.1007/s10096-010-1003-2 https://www.ncbi.nlm.nih.gov/pubmed/20623362/
has_full_text: TRUE
Keywords Extracted from Text Content: S. pneumoniae DNA patients M. pneumoniae Streptococcus pneumoniae Patients parainfluenza virus adenovirus human metapneumovirus urine Mycoplasma pneumoniae macrolide throat swabs sputum CRP blood cell patient p<0.05 human rhinoviruses EV pulmonary chest leukocytes adolescents outpatients co-infections mycoplasma enterovirus NL63 M. pneumoniae PSI human coronavirus hMPV Patients mycoplasma infections × C, parainfluenza virus (PIV) 1-4 adenovirus AdV peripheral HKU1 CAP blood convalescent pleural fluid cultures HRVs patients purulent sputum PSI<90 DNA Haemophilus influenzae sera Convalescent serum samples RSV 'cause leukocyte epithelial cells HCoV 229E S. pneumoniae B CAPNETZ OC43 quinolones Streptococcus pneumoniae M. pneumoniae isolates IgM antibodies human metapneumovirus L. pneumoniae nodules Sputum C-reactive Ran Chun-Lei Wang specimens NOVA Lin Wu Bin-Bin Li, Shan-Shan Wang Cui-Lian Li,
Extracted Text Content in Record: First 5000 Characters:Few studies have addressed the etiology and clinical outcomes of community-acquired pneumonia (CAP) treated in an ambulatory setting. We investigated the etiology by the culture of Mycoplasma pneumoniae, urine antigen testing of Streptococcus pneumoniae and Legionella pneumoniae, and DNA or RNA determination of eight kinds of respiratory virus DNA or RNA. An etiological diagnosis was made in 51.8% of 197 patients. The most common pathogens were M. pneumoniae (29.4%) followed by influenza virus A, parainfluenza virus, adenovirus, human metapneumovirus (9.6%), and S. pneumoniae (4.1%). Patients with mycoplasma infections were younger, less likely to have comorbidities, Drs. Bin Cao, Li-Li Ren, and Fei Zhao contributed equally to this paper. and less likely to have adequate sputum for gram stain and culture. Patients with viral infections were older and more likely to have poorly defined nodules on chest X-ray (CXR) or computed tomography (CT) scan. Among patients infected with M. pneumoniae, those with quinolones as initial prescriptions had shorter duration of fever after the initiation of antibiotics than patients with β-lactams, macrolides, or βlactams + macrolides (p<0.05). This study suggests that M. pneumoniae and respiratory viruses were the most frequent pathogens found in ambulatory adult CAP patients and quinolones were better than β-lactams, macrolides, or βlactams + macrolides in the resolution of fever of M. pneumoniae pneumonia. Community-acquired pneumonia (CAP) is one of the most clinically important diseases in adults, affecting 5 to 20 per 1,000 adults per year [1] . Fifty to eighty percent of patients with CAP are treated on an ambulatory basis [2] . However, most of our knowledge about the clinical manifestations and outcomes of CAP comes from studies among patients requiring admission to the hospital and CAP management guidelines have been influenced by these CAP etiology studies [3, 4] . Currently available evidence from randomized-controlled trials (RCT) scanning is insufficient to make evidence-based recommendations for the choice of antibiotic for the treatment of CAP in ambulatory patients [5] . Although CAP guidelines acknowledge respiratory viruses as a 'cause' of pneumonia, few recommendations are made regarding the management of viral pneumonia. From 1st August 2008 to 31st July 2009, consecutive adults and adolescents (≥14 years of age) seen in the fever clinic and who did not require hospitalization were prospectively enrolled in a surveillance study. None of the patients were immuno-compromised: patients with HIV infection, neutropenia, or who were receiving immunosuppressive chemotherapy were excluded. In addition, patients from nursing homes or patients who had been admitted to a hospital within the last 30 days were also excluded. After the first clinic encounter, all patients were followed-up by telephone within 7 to 28 days. Symptoms and signs were recorded daily. All patients suspected to have CAP had a chest X-ray (CXR). Only one patient had a normal CXR but a positive computed tomography (CT) scan. The pneumonia severity index (PSI) was used to assess the severity of illness [6] . Throat swabs were collected for Mycoplasma pneumoniae culture and polymerase chain reaction (PCR) assay [7] . Sputum and throat swabs were screened for the presence of respiratory syncytial virus (RSV), influenza virus (IFV) A, B, and C, parainfluenza virus (PIV) 1-4, human rhinoviruses (HRVs), enterovirus (EV), human coronavirus (HCoV 229E, OC43, NL63, and HKU1), human metapneumovirus (hMPV), and adenovirus (AdV), as previously reported [8, 9] . The microbial etiology was classified as 'definitive', 'presumptive', or 'unknown'. Bacteria were considered to be definitive causative agents when isolated from blood or pleural fluid cultures. If M. pneumoniae was isolated, it was considered to be a definitive pathogen. Legionella pneumophila and Streptococcus pneumoniae were considered to be a definite agent when the urinary antigen test was positive. The bacterial pathogen was considered to be 'presumptive' if a respiratory pathogen was isolated from purulent sputum (defined as an adequate quality sputum sample with >25 leukocytes and <10 epithelial cells per×100 magnification field). The presence of nucleic acids of M. pneumoniae and respiratory viruses from sputum or throat swabs by molecular methods was considered to be 'presumptive'. Comparisons of clinical characteristics and clinical outcomes were conducted between patients with known causative pathogens and without, using an unpaired Student's t-test, the Mann-Whitney test, or the Chi-square test (SPSS for Windows 13.0). Data from 197 adult CAP outpatients were available for analysis. Convalescent serum samples were not obtained in all patients. Overall, the median age of the patients was 32.5 years (range, 14 to 89 years), 49.7% were male, and 95.2% had mild CAP (PSI<90). A microbiological diagnosis was established in 102 patients (51.8%)
Keywords Extracted from PMC Text: hMPV Convalescent serum samples nodules blood cell patient NL63 quinolones ×100 enterovirus convalescent patients human metapneumovirus sputum sera HKU1 pleural fluid cultures M. pneumoniae adenovirus peripheral 's CRP purulent sputum EV mycoplasma infections CAPNETZ Patients L. pneumoniae epithelial cells human rhinoviruses Sputum S. pneumoniae mycoplasma C, parainfluenza virus (PIV) 1–4 throat swabs CAP AdV Haemophilus influenzae human coronavirus RSV HRVs M. pneumoniae isolates C-reactive B adolescents chest macrolide HCoV 229E OC43 leukocytes pulmonary leukocyte DNA PSI co-infections Streptococcus pneumoniae blood IgM antibodies
Extracted PMC Text Content in Record: First 5000 Characters:Community-acquired pneumonia (CAP) is one of the most clinically important diseases in adults, affecting 5 to 20 per 1,000 adults per year [1]. Fifty to eighty percent of patients with CAP are treated on an ambulatory basis [2]. However, most of our knowledge about the clinical manifestations and outcomes of CAP comes from studies among patients requiring admission to the hospital and CAP management guidelines have been influenced by these CAP etiology studies [3, 4]. Currently available evidence from randomized-controlled trials (RCT) scanning is insufficient to make evidence-based recommendations for the choice of antibiotic for the treatment of CAP in ambulatory patients [5]. Although CAP guidelines acknowledge respiratory viruses as a 'cause' of pneumonia, few recommendations are made regarding the management of viral pneumonia. From 1st August 2008 to 31st July 2009, consecutive adults and adolescents (≥14 years of age) seen in the fever clinic and who did not require hospitalization were prospectively enrolled in a surveillance study. None of the patients were immunocompromised: patients with HIV infection, neutropenia, or who were receiving immunosuppressive chemotherapy were excluded. In addition, patients from nursing homes or patients who had been admitted to a hospital within the last 30 days were also excluded. After the first clinic encounter, all patients were followed-up by telephone within 7 to 28 days. Symptoms and signs were recorded daily. All patients suspected to have CAP had a chest X-ray (CXR). Only one patient had a normal CXR but a positive computed tomography (CT) scan. The pneumonia severity index (PSI) was used to assess the severity of illness [6]. Throat swabs were collected for Mycoplasma pneumoniae culture and polymerase chain reaction (PCR) assay [7]. Sputum and throat swabs were screened for the presence of respiratory syncytial virus (RSV), influenza virus (IFV) A, B, and C, parainfluenza virus (PIV) 1–4, human rhinoviruses (HRVs), enterovirus (EV), human coronavirus (HCoV 229E, OC43, NL63, and HKU1), human metapneumovirus (hMPV), and adenovirus (AdV), as previously reported [8, 9]. The microbial etiology was classified as 'definitive', 'presumptive', or 'unknown'. Bacteria were considered to be definitive causative agents when isolated from blood or pleural fluid cultures. If M. pneumoniae was isolated, it was considered to be a definitive pathogen. Legionella pneumophila and Streptococcus pneumoniae were considered to be a definite agent when the urinary antigen test was positive. The bacterial pathogen was considered to be 'presumptive' if a respiratory pathogen was isolated from purulent sputum (defined as an adequate quality sputum sample with >25 leukocytes and <10 epithelial cells per ×100 magnification field). The presence of nucleic acids of M. pneumoniae and respiratory viruses from sputum or throat swabs by molecular methods was considered to be 'presumptive'. Comparisons of clinical characteristics and clinical outcomes were conducted between patients with known causative pathogens and without, using an unpaired Student's t-test, the Mann–Whitney test, or the Chi-square test (SPSS for Windows 13.0). Data from 197 adult CAP outpatients were available for analysis. Convalescent serum samples were not obtained in all patients. Overall, the median age of the patients was 32.5 years (range, 14 to 89 years), 49.7% were male, and 95.2% had mild CAP (PSI < 90). A microbiological diagnosis was established in 102 patients (51.8%). The most common pathogens were M. pneumoniae (29.4%), followed by respiratory viruses (9.6%) and S. pneumoniae (4.1%). Influenza virus A (IFVA) was the most common respiratory virus identified (6.1%), followed by parainfluenza virus (PIV), adenovirus (AdV), and human metapneumovirus (hMPV). The presence of two or three pathogens was detected in ten outpatients (5.1%). Five patients had co-infections with M. pneumoniae and respiratory virus; four had co-infections with bacteria and virus. One patient had three pathogens: Haemophilus influenzae, M. pneumoniae, and IFVA. Two (1%) of them were diagnosed as pulmonary tuberculosis by the positive culture of Mycobacterium tuberculosis from sputum (Table 1). None of the patients were tested positive for L. pneumoniae by urine antigen testing. Urinary antigen testing was positive for S. pneumoniae in four patients (two sputum and one blood culture positive for S. pneumoniae, the other was sputum culture negative). Patients with mycoplasma infections were younger than those with bacterial and viral infections (p < 0.001), had lower PSI score (p < 0.001), were less likely to have comorbidities (p = 0.003), and were less likely to have adequate sputum for gram stain and culture (p < 0.001). Patients with bacterial infections were more likely to have underlying diseases (p < 0.001) and had higher leukocyte count (p < 0.001). Patients with viral infections were older and more likely to have poorly defined
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