scholarly journals Predictors of pneumonia in lower respiratory tract infections: 3C prospective cough complication cohort study

2017 ◽  
Vol 50 (5) ◽  
pp. 1700434 ◽  
Author(s):  
Michael Moore ◽  
Beth Stuart ◽  
Paul Little ◽  
Sue Smith ◽  
Matthew J. Thompson ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Predictive Value ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Clinical Signs ◽  
Routine Practice ◽  
Lower Respiratory Tract Infections ◽  
Acute Cough ◽  
Presenting Symptoms ◽  
Tract Infections

The aim was to aid diagnosis of pneumonia in those presenting with lower respiratory tract symptoms in routine primary care.A cohort of 28 883 adult patients with acute cough attributed to lower respiratory tract infections (LRTIs) was recruited from 5222 UK practices in 2009–13. Symptoms, signs and treatment were recorded at presentation and subsequent events followed-up for 30 days by chart review. The predictive value of patient characteristics, presenting symptoms and clinical findings for the diagnosis of pneumonia in the first 7 days was established.Of the 720 out of 28 883 (2.5.%) radiographed within 1 week of the index consultation, 115 (16.0%; 0.40% of 28 883) were assigned a definite or probable pneumonia diagnosis. The significant independent predictors of radiograph-confirmed pneumonia were temperature >37.8°C (RR 2.6; 95% CI 1.5–4.8), crackles on auscultation (RR 1.8; 1.1–3.0), oxygen saturation <95% (RR 1.7; 1.0–3.1) and pulse >100·min–1(RR 1.9; 1.1–3.2). Most patients with pneumonia (99/115, 86.1%) exhibited at least one of these four clinical signs; the positive predictive value of having at least one of these signs was 20.2% (95% CI 17.3–23.1).In routine practice, radiograph-confirmed pneumonia as a short-term complication of LRTI is very uncommon (one in 270). Pulse oximetry may aid the diagnosis of pneumonia in this setting.

Clinical Utility of In-house Metagenomic Next-generation Sequencing for the Diagnosis of Lower Respiratory Tract Infections and Analysis of the Host Immune Response

2020 ◽  
Vol 71 (Supplement_4) ◽  
pp. S416-S426
Author(s):  
Hongbin Chen ◽  
Yuyao Yin ◽  
Hua Gao ◽  
Yifan Guo ◽  
Zhao Dong ◽  
...  
Keyword(s):  
Next Generation Sequencing ◽  
Respiratory Tract ◽  
Predictive Value ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Next Generation ◽  
Lower Respiratory Tract Infections ◽  
Dna And Rna ◽  
Tract Infections ◽  
Generation Sequencing

Abstract Background Only few pathogens that cause lower respiratory tract infections (LRTIs) can be identified due to limitations of traditional microbiological methods and the complexity of the oropharyngeal normal flora. Metagenomic next-generation sequencing (mNGS) has the potential to solve this problem. Methods This prospective observational study sequentially enrolled 93 patients with LRTI and 69 patients without LRTI who visited Peking University People’s Hospital in 2019. Pathogens in bronchoalveolar lavage fluid (BALF) specimens were detected using mNGS (DNA and RNA) and traditional microbiological assays. Human transcriptomes were compared between LRTI and non-LRTI, bacterial and viral LRTI, and tuberculosis and nontuberculosis groups. Results Among 93 patients with LRTI, 20%, 35%, and 65% of cases were detected as definite or probable pathogens by culture, all microbiological tests, and mNGS, respectively. Our in-house BALF mNGS platform had an approximately 2-working-day turnaround time and detected more viruses and fungi than the other methods. Taking the composite reference standard as a gold standard, it had a sensitivity of 66.7%, specificity of 75.4%, positive-predictive value of 78.5%, and negative-predictive value of 62.7%. LRTI-, viral LRTI–, and tuberculosis-related differentially expressed genes were respectively related to immunity responses to infection, viral transcription and response to interferon-γ pathways, and perforin 1 and T-cell receptor B variable 9. Conclusions Metagenomic DNA and RNA-seq can identify a wide range of LRTI pathogens, with improved sensitivity for viruses and fungi. Our in-host platform is likely feasible in the clinic. Host transcriptome data are expected to be useful for the diagnosis of LRTIs.

scholarly journals 738. Role of Respiratory Syncytial Virus and Mycoplasma pneumoniae in Pediatric Community-Acquired Lower Respiratory Tract Infections

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S265-S265
Author(s):  
Sanchit Kumar ◽  
Anita Chakravarti ◽  
Surinder Kumar ◽  
Seema Kapoor
Keyword(s):  
Respiratory Tract ◽  
Predictive Value ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Rt Pcr ◽  
Lower Respiratory Tract Infections ◽  
Rsv Infection ◽  
Syncytial Virus ◽  
Tract Infections

Abstract Background Respiratory syncytial virus (RSV) infection is a major cause of serious lower respiratory disease in infancy and early childhood and Mycoplasma pneumoniae (M. pneumoniae) is a common cause of respiratory tract infections in all age groups. This study was conducted to determine the role of RSV and M. pneumoniae and in pediatric lower respiratory tract infections employing serological tests, polymerase chain reaction (PCR) and reverse transcriptase PCR analysis. Methods In this prospective study, 75 children aged 1 month to 5 years with acute lower respiratory tract infections (LRTIs) were investigated. Paired serum samples were obtained on admission and after 4–6 weeks to assay for M. pneumonia antibodies. Nasopharyngeal aspirates were obtained for the detection of RSV antigen by using the immunochromatographic test, reverse transcriptase-polymerase chain reaction (RT-PCR) for RSV and M. pneumoniae by PCR. Results RSV infection was positive in 20(60.60%) children aged &lt;1 year and 13 (39.40%) aged 2–5 years, the difference being statistically insignificant (P = 0.360). M. pneumoniae infection was documented in a 15(57.6%) children aged &lt;1 year age and 11(42.4%) in age 2–5 years which was statistically significant(P = 0.026). Clinical and radiological features among RSV and M. pnemoniae positive and negative cases were comparable. Thirty (40%) children were positive for RSV antigen and by RT-PCR and 3(12%) only by RT-PCR. Serological evidence of M pneumoniae infection was documented in 24(32%) children. M. pnemoniae PCR was positive in 8 (10.66%) patients. Together, serology and PCR detected M. pneumoniae in 26(34.66%) children. Considering RT-PCR as a diagnostic standard, the sensitivity of RSV antigen by immunochromatography was 90.90%, specificity 100%, positive predictive value 100% and a negative predictive value of 93.3%.The sensitivity of M. pneumoniae serology was 75%, specificity 73.3%, positive predictive value 25% and a negative predictive value of 96% considering PCR as a diagnostic standard,. Conclusion Our data underline the role of RSV and M. pneumoniae as the major cause of community-acquired lower respiratory tract infections in children aged &lt;5 years. Disclosures All authors: No reported disclosures.

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