quantitative polymerase chain reaction for improved detection of pneumococci in cap "captain"

Conditions: Pneumonia, Pneumococcal; Community-acquired Pneumonia

Summary: the purpose of this study is to evaluate the added diagnostic value of a quantitative polymerase chain reaction targeting the lyta gene in detecting pneumococci in patients with community-acquired pneumonia.


Eligibility criteria:
inclusion criteria: patients: * age 18 years or above; * presentation at the emergency department (ed); * working diagnosis of cap at the ed with the presence of at least two of the following criteria: 1. new or worsened coughing; 2. production of purulent sputum or change in sputum colour; 3. temperature \>38.0 ⁰c or ≤36.0 ⁰c (tympanic); 4. auscultatory findings consistent with pneumonia, including rales, evidence of pulmonary consolidation (dullness on percussion, bronchial breath sounds, rales, or egophony), or both; 5. white blood cell count of \>10x10\^9 cells/l or \ 15% bands; 6. c-reactive protein level ≥30mg/l; 7. dyspnea, tachypnea, (\>20 breaths per minute), or hypoxemia (arterial po2 \<60mmhg or peripheral o2 saturation \<90%). * new consolidation(s) on the chest radiograph or computed tomography (ct); * no other explanation for the signs and symptoms; control group 1 - related controls * being aged 18 years or above; * close relative of the patient: relative defined as living in the same house as the cap patient or daily contact; * is at the hospital at the moment of inclusion of the cap patient or is willing to come for testing within 7 days; control group 2 - unrelated healthy individuals * being aged 18 years or above; * subject with a preoperative appointment with the anaesthiologist for a planned surgical procedure; * age matched to a included cap patient (+-10 years); * time matched to a included cap patient (up to 14 days after inclusion of the cap patient); * gender matched to a included cap patient. control group 3 - patients with stable copd * being aged 18 years or above; * diagnosis of copd confirmed with spirometry (gold criteria 2017)(76); * stable disease. control group 4 - patients with exacerbation of copd * being aged 18 years or above; * diagnosis of copd confirmed with spirometry (gold criteria 2017)(76); * diagnosis of exacerbation of copd: defined as an acute event characterised by a worsening of the patient's respiratory symptoms that is beyond normal day-to-day variations and leads to a change in medication (76). * presentation at emergency department with the suspicion of an exacerbation. exclusion criteria: in general: * recent pneumonia (\< 1 month) or pneumonia in last 3 months with known pneumococcal aetiology with one of current diagnostics; * was included in the study group before; * not capable of understanding information needed to sign informed consent. patients: * aspiration pneumonia; * hospitalisation for two or more days in the last 14 days; * history of cystic fibrosis. for all control groups: * fits inclusion criteria for patient group; * present or recent hospitalisation (14 days); * fits inclusion criteria for patient group; * use of antibiotics in the last 14 days, including maintenance antibiotic therapy. control group 1 and 2 - related healthy controls and unrelated healthy individuals * active infectious respiratory complaints defined as defined as two or more respiratory symptoms (cough, nasal congestion, runny nose, sore throat or sneezes); * temperature \>38.0 ⁰c; * fits inclusion criteria for control group 3 or 4; * chronic pulmonary disease: copd, asthma, cystic fibrosis, bronchiectasis. control group 3 - patients with stable copd * temperature \>38.0 ⁰c; * stable disease; * fits inclusion criteria for control group 4; * recent exacerbation (\<1 month) defined as increased respiratory symptoms with need of antibiotic and/or corticosteroid therapy; * history of cystic fibrosis. control group 4 - patients with exacerbation of copd * current pneumonia; * recent exacerbation (\<1 month) defined as increased respiratory symptoms with need of antibiotic and/or corticosteroid therapy; * fits inclusion criteria for control group 3; * history of cystic fibrosis.

Keywords: quantitative polymerase chain reaction qpcr autolysin lyta pneumococcal pneumonia diagnostics community-acquired pneumonia antibiotic resistance