title: The clinical and public health value of non-culture methods in the investigation of a cluster of unexplained pneumonia cases.
abstract: During 2003, a cluster of initially unexplained pneumonia cases (two fatal) occurred in patients aged <50 years in a British city. Routine culture tests were inconclusive, however, pneumococcal infection was suspected and the putative outbreak was investigated using non-culture methods. Clinical samples from ten patients were tested by pneumococcal polymerase chain reaction (PCR) and multi-locus sequence typing (MLST), or Binax NOW pneumococcal urine antigen test and serotype-specific enzyme-linked immunosorbent assay (ELISA). Lung samples from the deceased patients were PCR positive and yielded different MLST types. Two patients in one family group were serotype 1 pneumococcal antigen positive. Two further patients were serotype 1 antigen positive, and one serotype 4 positive. Two antigen-positive cases were also serum PCR positive. Non-culture methods confirmed the disease aetiology in six cases. Serotype and MLST results showed no single outbreak, but a family cluster of cases in a high background of pneumococcal pneumonia, providing important epidemiological data that would not otherwise have been available.
authors: Respiratory and Systemic Infection Laboratory, Health Protection Agency, Centre for Infections, London, UK. carmen.sheppard@hpa.org.uk
authors: C L
authors: CL
authors: Sheppard
authors: J E
authors: JE
authors: Salmon
authors: T G
authors: TG
authors: Harrison
authors: M
authors: M
authors: Lyons
authors: R C
authors: RC
authors: George
mesh_terms: D000293:Adolescent; D000328:Adult; D000942:Antigens, Bacterial / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000235:genetics; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007118:Immunoassay / Q000379:methods; D008168:Lung / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis* / Q000453:epidemiology* / Q000382:microbiology; D016133:Polymerase Chain Reaction / Q000379:methods; D017422:Sequence Analysis, DNA / Q000379:methods; D012703:Serotyping; D044967:Serum / Q000382:microbiology; D013296:Streptococcus pneumoniae / Q000145:classification / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D006113:United Kingdom / Q000453:epidemiology; D014556:Urine / Q000382:microbiology
chemical_list: D000942:Antigens, Bacterial; D004269:DNA, Bacterial
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