title: Broad-range bacterial detection and the analysis of unexplained death and critical illness.
abstract: Broad-range rDNA polymerase chain reaction (PCR) provides an alternative, cultivation-independent approach for identifying pathogens. In 1995, the Centers for Disease Control and Prevention initiated population-based surveillance for unexplained life-threatening infections (Unexplained Death and Critical Illness Project [UNEX]). To address the causes of UNEX cases, we examined 59 specimens from 46 cases by using broad-range bacterial 16S rDNA PCR and phylogenetic analysis of amplified sequences. Specimens from eight cases yielded sequences from Neisseria meningitidis (cerebrospinal fluid from two patients with meningitis), Streptococcus pneumoniae (cerebrospinal fluid from one patient with meningitis2 and pleural fluid from two patients with pneumonia), or Stenotrophomonas maltophilia (bone marrow aspirate from one patient with pneumonia). Streptococcus pneumoniae rDNA sequence microheterogeneity was found in one pleural fluid specimen, suggesting the presence of multiple strains. In conclusion, known bacterial pathogens cause some critical illnesses and deaths that fail to be explained with traditional diagnostic methods.
authors.affiliation: Stanford University School of Medicine, California, USA.
authors.forename: Simo
authors.initials: S
authors.lastname: Nikkari
authors.forename: Fred A
authors.initials: FA
authors.lastname: Lopez
authors.forename: Paul W
authors.initials: PW
authors.lastname: Lepp
authors.forename: Paul R
authors.initials: PR
authors.lastname: Cieslak
authors.forename: Stephen
authors.initials: S
authors.lastname: Ladd-Wilson
authors.forename: Douglas
authors.initials: D
authors.lastname: Passaro
authors.forename: Richard
authors.initials: R
authors.lastname: Danila
authors.forename: David A
authors.initials: DA
authors.lastname: Relman
mesh_terms: D000293:Adolescent; D000328:Adult; D001424:Bacterial Infections / Q000235:genetics / Q000401:mortality*; D002423:Cause of Death; D002487:Centers for Disease Control and Prevention, U.S.; D002648:Child; D016638:Critical Illness / Q000401:mortality; D004269:DNA, Bacterial / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008297:Male; D016133:Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D012720:Severity of Illness Index; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D014481:United States / Q000453:epidemiology
chemical_list: D004269:DNA, Bacterial