The clinical and public health value of non-culture methods in the investigation of a cluster of unexplained pneumonia cases.
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.
Sheppard
C L
CL
Respiratory and Systemic Infection Laboratory, Health Protection Agency, Centre for Infections, London, UK. carmen.sheppard@hpa.org.uk
Salmon
J E
JE
Harrison
T G
TG
Lyons
M
M
George
R C
RC
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
D000942:Antigens, Bacterial; D004269:DNA, Bacterial
Clin Infect Dis. 2002 Jan 1;34(1):E1-11
11731965
J Clin Microbiol. 2003 Jan;41(1):521-2
12517914
J Clin Microbiol. 2003 Jul;41(7):2810-3
12843005
J Clin Microbiol. 2003 Nov;41(11):4966-70
14605125
Commun Dis Public Health. 2003 Sep;6(3):221-7
14708272
J Clin Microbiol. 2005 Oct;43(10):4972-6
16207950
Am J Med. 1983 Jul 28;75(1B):85-92
6309001
Clin Infect Dis. 1992 Apr;14(4):801-7
1576274
Commun Dis Public Health. 1998 Mar;1(1):22-7
9718833
J Clin Microbiol. 2005 Apr;43(4):2004-8
15815045
J Med Microbiol. 2004 Mar;53(Pt 3):189-95
14970243