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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To determine the usefulness of the quantitative serum C-reactive protein (CRP) concentration as a tool in differentiating acute pneumonia from other acute lower respiratory tract infection (ALRI), and in assessing response to therapy serum CRP concentrations were measured in 30 children with pneumonia, 30 with acute bronchitis and 5 with bronchiolitis. All the pneumonia patients had a serum CRP level above 83 mg/l (mean 157; SD +/- 47 mg/l) whereas none of the acute bronchitis (mean 7.8; SD +/- 5.7 mg/l) or bronchiolitis patients and normal children (mean +/- 3.5 SD +/- 2.7 mg/l) had a level above 35 mg/l. The sensitivity and positive predictive value of CRP level greater than 35 mg/l for diagnosis of pneumonia was 100%. On serial monitoring a fall in CRP concentration also provided the earliest clue to therapeutic response, much before a fall in temperature, respiratory rate or ESR.
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PMID:Value of C-reactive protein concentration in diagnosis and management of acute lower respiratory infections. 269 85

An open multicentre study of the efficacy and side effects of roxithromycin, a new macrolide antibiotic, in the treatment of community acquired pneumonia was undertaken. The diagnosis was verified by transtracheal aspiration. Fifty-three patients were studied. In the 49 patients evaluable the clinical efficacy rate was 92% (95% confidence limits 84-100%). Only by measurement of the fall in serum C-reactive protein was it possible to detect a difference in response between pneumonia due to Streptococcus pneumoniae and Haemophilus influenzae. The drug was well tolerated clinically and laboratory abnormalities included transient eosinophilia and elevated liver enzymes in two patients.
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PMID:Roxithromycin in the treatment of pneumonia. 275 23

Fifty-seven children ages 1 month to 12 years hospitalized because of community-acquired pneumonia were compared with age-matched controls who had acute asthma without pneumonia to test the value of rapid bacterial antigen detection and clinical and radiographic criteria for diagnosis of bacterial pneumonia. Bacterial pneumonia, defined on the basis of positive cultures of blood or pleural fluid, was diagnosed in 4 children (7%), 1 of whom also had viral pneumonia. Viral pneumonia, defined as a positive nasopharyngeal sample or positive serology, was diagnosed in 20 children (35%). Serum and concentrated urine were tested by latex agglutination (Wellcogen) for Haemophilus influenzae type b and pneumococcal antigens and by countercurrent immunoelectrophoresis for pneumococcal antigens. Pneumococcal antigen could not be detected in serum or urine from 3 children with culture-proved pneumococcal pneumonia, indicating poor sensitivity of the tests. In contrast apparent H. influenzae type b antigenuria was detected by latex agglutination in 4 of 40 children with pneumonia but also in 5 of 57 controls, and a sensitive enzyme-linked immunosorbent assay for polyribosyl ribitol (PRP) phosphate antigen showed that all 9 cases were false positives. The specificity of H. influenzae type b antigen detection was thus poor. Children with viral and bacterial pneumonia could not be distinguished by radiographic or clinical criteria (symptoms, fever) or by total or differential white blood cell counts, serum C-reactive protein or nasal or serum interferon levels. It is not possible to distinguish reliably childhood viral from bacterial pneumonia clinically or by rapid diagnostic tests.
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PMID:Problems in determining the etiology of community-acquired childhood pneumonia. 278 61

The combined use of microbiological, serological and clinical laboratory methods was evaluated for etiological diagnosis of pneumonia in 106 military conscripts. Special attention was paid to rapid diagnosis of pneumococcal pneumonia and its differentiation from viral and mycoplasmal pneumonia. The microbial etiology could be established in 91 (86%) of the pneumonia patients. Pneumococcal etiology was definitely established in 32 (30%) patients and considered probable in an additional 21 patients (20%). Infection with Mycoplasma pneumoniae and adenovirus was confirmed in 23 (22%) of the patients. Mixed infections was observed in 28 (31%) of the patients with established etiology. Detection of pneumococcal antigen was the best rapid diagnostic method, being positive in 90% of the patients with purulent sputum samples in the group with a definite diagnosis of pneumococcal pneumonia prior to the start of antimicrobial treatment, while Gram stain was positive in only 65% of these patients. Sputum purulence could be used to differentiate very significantly pneumococcal from viral and mycoplasmal pneumonia (p less than 0.001). These categories of pneumonia could also be successfully differentiated by clinical laboratory tests, of which the white blood cell count and C-reactive protein were most useful. The suggested cut-off value for the cell count was 10 X 10(9)/l, and for C-reactive protein 85 mg/l. These tests could not differentiate viral from mycoplasmal pneumonias.
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PMID:Etiological diagnosis of pneumonia in military conscripts by combined use of bacterial culture and serological methods. 313 34

The changes in serum triglycerides, cholesterol and high density lipoprotein (HDL) cholesterol were followed in patients with pneumonia caused by different bacteria or viruses as well as in those with no defined aetiology. In the acute phase of the disease there was: 1) a fall in serum triglycerides in patients with bacteremic pneumococcal disease and in patients with no defined aetiology (p less than 0.01 and less than 0.005, respectively). 2) a reduction in cholesterol in all aetiological groups (p less than 0.001) except for those with viral pneumonias, where only 4 patients were studied, and 3) a fall in HDL cholesterol in all the groups (at least at p less than 0.05) except in those with virus infection. 4) In bacteraemic pneumococcal disease the cholesterol level (mean 2.6, SEM 0.3 mmol/l) was lower than that in the other groups (at least at p less than 0.05). In the acute phase there was a tendency to a negative correlation of erythrocyte sedimentation rate and of C-reactive protein with serum cholesterol and/or HDL cholesterol. Changes in serum lipids in various infections deserve further pathophysiological investigation.
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PMID:Serum lipids in pneumonia of different aetiology. 319 82

Because of lower respiratory infection that was treated with antibiotics on the suspicion of pneumonia, 71 patients aged 15 years or more were referred to the study by general practitioners. Using a positive chest X-ray as a "gold standard", 15% had pneumonia. The diagnostic value of variables from history, physical examination and blood tests was evaluated by calculating the likelihood ratio (LR). A duration of illness less than 24 hours before consulting the general practitioner was the variable from the history with the highest LR, 13.5. The white blood cell count and particularly the C-reactive protein analysis had a high diagnostic value, CRP greater than 50 mg/l had an LR of 37. In this selected material pulmonary symptoms and lung findings were of minor value in differentiating patients with and without pneumonia, with no LR exceeding 2.3. This can be explained to some extent by selection bias.
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PMID:The diagnosis of adult pneumonia in general practice. The diagnostic value of history, physical examination and some blood tests. 338 6

Clinical characteristics and course of disease of 19 pneumococcal, 11 adenoviral, 15 mycoplasmal and 10 mixed pneumonias, diagnosed in 55 military conscripts, were compared. Controls consisted of 104 conscripts with upper respiratory infections (URI). The triad: productive cough, blood stained sputum, and chest pain aggravated by breathing (pneumococcal score) distinguished pneumococcal and mixed pneumonias but not adenoviral and mycoplasmal pneumonias from URI. Higher C-reactive protein (CRP) and white blood cell (WBC) count distinguished the pneumococcal pneumonias, but not the other pneumonias, from URI. The pneumococcal scores and simple laboratory tests on admission were compared. The score effectively separated pneumococcal from adenoviral and mycoplasmal pneumonias, and patients with mixed infections from mycoplasmal infections. Higher CRP values and WBC counts distinguished pneumococcal pneumonia from other pneumonias. Auscultation revealed crackles in 27% of adenoviral and in 60-70% of mycoplasmal, pneumococcal and mixed pneumonias. Maxillary sinusitis was more common in pneumococcal (56%) than in mycoplasmal (7%) or mixed pneumonia (10%) or URI (14%). Pneumococcal pneumonias differed in most respects from the other groups. It is difficult to distinguish between adenoviral, mycoplasmal and mixed pneumonia and also URI.
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PMID:Clinical diagnosis of pneumococcal, adenoviral, mycoplasmal and mixed pneumonias in young men. 339 72

Serial quantitative measurements of C-reactive protein (CRP) were performed, using an automated enzyme immunoassay method, in 127 neonates (114 premature and 13 full-term) classified in three groups: neonates with a normal postnatal course (group 1, n = 69), neonates with clinical suspicion of bacterial infection but with negative cultures (group 2, n = 49), and neonates with proven bacterial infection (group 3, n = 9). A total of 545 serial serum CRP concentrations were determined. In group 1, CRP concentrations were below the detection limit of the method (10 mg/L) except in one neonate who suffered from neonatal anoxia but whose clinical course was uncomplicated (CRP: 31 mg/L within 24 h of life). Thirty-three neonates of group 2 had CRP values consistently below 10 mg/L while 16 had elevated CRP concentrations at least on one occasion ranging from 10 to 70 mg/L. Diagnoses other than bacterial infection could explain the raised CRP concentrations in neonates of group 2. CRP concentrations were found to be elevated (greater than 80 mg/L) during the course of infectious diseases in all neonates with proven bacterial infection (septicemia (4), pneumonia (1), multiple micro-abscesses (1), urinary tract infection (3]. Serial measurement of CRP concentrations are shown to be valuable in detecting bacterial infection in neonates as well as in following the efficacy of antimicrobial therapy.
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PMID:C-reactive protein as biochemical indicator of bacterial infection in neonates. 352 99

A prospective study of 250 consecutive neonatal admissions to a regional perinatal referral centre and of 10 additional consecutive cases with culture-proven neonatal septicaemia was undertaken. Quantitative C-reactive protein (CRP) determination, white cell count and differential were performed on blood samples obtained from all babies on admission, as well as 10-14 h and 22-26 h later. Using clinical signs, chest X-rays, blood cultures, tracheal aspirates obtained within 4 h of delivery and an abnormal immature/total neutrophil ratio (I/T), infected babies were defined as belonging to one of the following groups: culture-proven septicaemia (n = 19); clinical septicaemia (n = 35); congenital pneumonia (n = 28). The sensitivity, specificity, positive and negative predictive value of CRP were calculated for each sampling time and patient group. No baby had a rise in CRP (greater than 6 mg/l) before an abnormal I/T ratio was first detected. A delayed rise in CRP concentration in the majority of infected babies occurred approximately 12-24 h after the abnormal I/T ratio was first detected. The overall specificity of a CRP level of greater than or equal to 10 mg/l remained approximately constant (97%-94%) while sensitivity increased from 22%-61% with increasing time after admission. The same pattern emerged if each patient group was considered separately. The positive predictive value for a CRP level of greater than or equal to 10 mg/l 22-26 h after admission was 83% and the negative predictive value 82%. CRP had no value in the early diagnosis of neonatal infection. Its main role lies rather in the exclusion or confirmation of infection 24 h after the first clinical suspicion.
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PMID:Diagnostic audit of C-reactive protein in neonatal infection. 356 51

The interrelationships between various components of the non-immune inflammatory response (white cell count, plasma lactoferrin, C-reactive protein, ferritin, iron and iron-binding capacity), were studied serially in a variety of inflammatory conditions including acute lobar pneumonia, active pulmonary tuberculosis, rheumatoid arthritis on gold therapy and sepsis in the face of marrow hypoplasia induced by chemotherapy. Lactoferrin concentrations paralleled the white count in all groups. They were highest in pneumonia and tuberculosis, mildly elevated in rheumatoid arthritis and markedly decreased in neutropenic sepsis. Very high initial lactoferrin concentrations were associated with a poor prognosis in acute pneumonia. C-reactive protein and ferritin concentrations remained elevated through the period of study in acute pneumonia and neutropenic sepsis, while they gradually normalised over weeks in subjects with tuberculosis or rheumatoid arthritis on therapy. In pneumonia and tuberculosis moderate hypoferraemia and a reduced iron-binding capacity were evident. In contrast, a raised percentage saturation was present in neutropenic sepsis, probably related to erythroid marrow suppression. Comparisons between ferritin, lactoferrin and C-reactive protein in the various groups supported the concept that ferritin behaves in part as an acute phase reactant and that hypoferraemia in inflammation is due to deviation of iron into ferritin stores. The suggestion that lactoferrin is responsible for the hypoferraemia and hyperferritinaemia was not supported by the present data. Iron deficiency appeared to limit the hyperferritinaemic response in rheumatoid arthritis, while erythropoietic inhibition by chemotherapy dampened the hypoferraemic response in neutropenic sepsis.
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PMID:The non-immune inflammatory response: serial changes in plasma iron, iron-binding capacity, lactoferrin, ferritin and C-reactive protein. 378 68


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