Document 0639
 DOCN  M9610639
 TI    Community-acquired pneumonia: impact of immune status.
 DT    9601
 AU    Mundy LM; Auwaerter PG; Oldach D; Warner ML; Burton A; Vance E; Gaydos
       CA; Joseph JM; Gopalan R; Moore RD; et al; Department of Medicine, Johns
       Hopkins Medical Institutions,; Baltimore, Maryland, USA.
 SO    Am J Respir Crit Care Med. 1995 Oct;152(4 Pt 1):1309-15. Unique
       Identifier : AIDSLINE MED/96023209
 AB    This cross-sectional and prospective one year study evaluated adults
       admitted to an inner city hospital with community-acquired pneumonia.
       The study used extensive diagnostic methods to evaluate the etiologies
       of community-acquired pneumonia in hospitalized patients with differing
       immunologic status. Of 385 study patients, concurrent problems
       associated with immunosuppression were noted in 221 (57%) patients, 180
       of whom were human immunodeficiency virus (HIV)-infected. The five most
       common causes of community-acquired pneumonia were: Streptococcus
       pneumoniae, Pneumocystis carinii, aspiration, Hemophilus influenzae, and
       gram-negative bacilli. Only 8.3% of patients had either Legionella,
       Chlamydia pneumoniae or Mycoplasma pneumoniae. Despite use of
       state-of-the-art diagnostic techniques, no diagnosis was made in 46 of
       180 (25.6%) HIV-infected patients, 56 of 164 (34.1%) immunocompetent
       patients, and 20 of 41 (48.8%) non-HIV-infected immunosuppressed
       patients. The diagnostic yield of pre-antibiotic sputum culture for
       conventional bacteria was 99/155 (63.9%) compared to 52 of 169 patients
       (32.7%) with adequate post-antibiotic sputum culture (p < 0.0001).
       Although S. pneumonia continues to be the most commonly identified
       etiologic agent of community-acquired pneumonia, it is surpassed by P.
       carinii in the HIV-infected patient population. The apparent decline in
       the frequency of S. pneumoniae in our series presumably reflects
       administration of antibiotics prior to procurement of sputum culture.
       The paucity of atypical agents in this study support the current
       American Thoracic Society guidelines for selective use of macrolide
       therapy in immunocompetent adults hospitalized with community-acquired
       pneumonia.(ABSTRACT TRUNCATED AT 250 WORDS)
 DE    Adult  AIDS-Related Opportunistic Infections/EPIDEMIOLOGY/*IMMUNOLOGY/
       MICROBIOLOGY  Baltimore/EPIDEMIOLOGY  Community-Acquired
       Infections/EPIDEMIOLOGY/IMMUNOLOGY/  MICROBIOLOGY  Comparative Study
       Cross-Sectional Studies  Female  Human  *Immunocompromised Host  Male
       Middle Age  Pneumonia/EPIDEMIOLOGY/*IMMUNOLOGY/MICROBIOLOGY  Pneumonia,
       Pneumocystis carinii/EPIDEMIOLOGY/IMMUNOLOGY  Prospective Studies
       JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).