1 Bulletin of the World Health Organization, 64 (4): (1986) World Health Organization 1986 The etiology of lobar pneumonia in the Gambia* R. A. WALL,' P. T. CORRAH,2 D. C. W. MABEY,2 & B. M. GREENWOOD2 Sixty-four patients who had been admitted to hospital in the Gambia with acute lobar pneumonia were investigated. Lung aspiration proved to be the most effective method of establishing a bacterial etiology, and Streptococcus pneumoniae was the pathogen isolated most frequently from patients irrespective of age. Among children, Haemophilus influenzae, either singly or in combination with another bacterial agent, was an important cause of pneumonia. Of 13 isolates of H. influenzae two were of serotype a, while four others were non-capsulated. All isolates of S. pneumoniae and H. influenzae were sensitive to penicillin. Acute gastrointestinal and acute respiratory infections are two of the most important causes of mortality and morbidity in most developing countries, including the Gambia. While considerable progress has been made in determining the etiology of acute diarrhoeal diseases and in defining a strategy for their treatment and prevention, less attention has been paid to acute respiratory infections. Indeed, in many developing countries the etiology of acute respiratory infections in children is unknown, and the relative importance of bacterial and viral causative agents is undetermined (1). The difficulties of establishing a firm bacterial etiology for patients with pneumonia are well known. Culture of sputum is of uncertain value, while blood culture provides a definitive diagnosis but is positive in only 20-30% of patients. Although analysis of sputum for capsular polysaccharide antigens may be of diagnostic value in adults (2-4), samples of sputum are difficult to obtain from children. Alternative approaches to the diagnosis of acute respiratory infections in children include the use of invasive diagnostic techniques such as lung aspiration (5-9) and sensitive serological tests for the detection of bacterial antigens in biological fluids (10-12). As a preliminary survey, prior to a more comprehensive study of respiratory infections among children in the Gambia, we investigated the etiology of pneumonia in a group of hospitalized patients using the following techniques: lung aspiration, blood culture, and detection of antigen in serum. * From the Medical Research Council Laboratories, Fajara, Banjul, Gambia. ' Consultant Medical Microbiologist, Northwick Park Hospital, Harrow, Middlesex, HAI 3UJ, England. Requests for reprints should be sent to this author. 2 Medical Research Council Laboratories, Fajara, Banjul, Gambia MATERIALS AND METHODS Patients During the period December 1982 to January 1984 a total of 207 patients with pneumonia were admitted to the Medical Research Council Hospital, Fajara, Gambia. Of these, 64 who had had symptoms for less than 7 days' duration, for whom clinical and/or radiological evidence of pulmonary consolidation was available, and who agreed to be investigated by lung aspiration, formed the basis of the study. Patients suspected to have post-measles pneumonia and those with severe malnutrition complicated by pneumonia were excluded. None of the study patients was known to have had prior treatment with antibiotics. Lung aspiration Lung aspiration was carried out in the region of maximum pulmonary consolidation using a 21-gauge needle attached to a 10-ml syringe containing 1-2 ml Mueller-Hinton broth. a Patients' skin was first cleansed with 70% (v/v) isopropyl alcohol. As soon as the skin had been penetrated, the plunger of the syringe was withdrawn slightly, the needle inserted quickly into the lung, and removed without a pause. The aspirate in the syringe was then transferred to a sterile tube, which was centrifuged for 10 minutes in a bench-top centrifuge. The centrifugate was used to prepare smears for Gram-staining, to inoculate chocolate agar (5% defibrinated horse blood in blood agar base No. 2a), blood agar (5% sheep blood in Columbia basea), and Robertson's cooked meat culture medium. There were no complications arising from the lung aspiration. ' From Oxoid, Basingstoke, Hampshire, England.
2 554 R. A. WALL ET AL. Bacteriology Primary culture plates obtained from lung aspirates were incubated for 48 hours in a candle jar until negative. Subsequently, Robertson's cooked meat culture medium was subcultured for 48 hours onto blood agar incubated in a mixture of air and carbon dioxide, anaerobically, and onto chocolate agar. Venous blood from patients was inoculated into nutrient broth with liquoid (sodium polyanethyl sulfonate) and into tryptone soya broth with liquoid. Subcultures were performed at intervals of 24 and 48 hours, and 7 days. Subsequent growths of colonies were identified by standard techniques. Haemophilus influenzae was biotyped using the method described by Kilian (13) involving indole, urease (EC ), and ornithine decarboxylase (EC ) activity; H. influenzae and Streptococcus pneumoniae were serotyped by coagglutination or countercurrent immunoelectrophoresis (CIE) using type-specific serum!" C Antibiotic sensitivity testing The sensitivity of the method was determined by comparative disc diffusion (Stokes' method) using Staphylococcus aureus NCTC 6571 as a control and the following antibiotics in the disc: penicillin 0.25 IU, chloramphenicol 10 Ag, tetracycline 10 Ag, jg. sulfamethoxazole 25 gg, and trimethoprim 1.25 Isolates showing reduced sensitivity were further investigated by the antibiotic-incorporated, agarplate dilution methods. Detection of bacterial antigens Sera were analysed for capsular polysaccharide antigens by CIE using pneumococcal omniserumd and H. influenzae type b antiserume (14). The sensitivity of this technique was determined for 14 purified polysaccharides of S. pneumoniae (types 1, 2, 3, 4, 6A, 8, 9N, 12F, 14, 19F, 23F, 25, 7F, and 18C, Danish classification)! The sensitivity of the assay ranged from 5 ug/ml for type 14 polysaccharide to 100 ng/ml for types 3, 6, 7, and 9 polysaccharide. Selected sera were examined for pneumococcal antigens by a micro-elisa technique. Briefly, a -yglobulin precipitate of pneumococcal omniserum diluted to a concentration of 10 ilg/ml in carbonate b Type-specific serum Difco, Detroit, MI, USA. for H. influenzae was obtained from ' Type-specific serum for S. pneumoniae was obtained from Statens Seruminstitut, Copenhagen, Denmark. d Staten Seruminstitut, Copenhagen, Denmark. ' Difco, Detroit, MI, USA. f Samples of polysaccharides were kindly supplied by Merck, Sharp & Dohme, Hoddesdon, Hertfordshire, England. buffer (ph 9.6) was adsorbed by incubation for 16 hours at 4 C onto the cavities of a 96-well microtitration plate.! Unfilled binding sites were blocked by incubation for 1 hour at 37 C with PBS-Tween containing 5% newborn calf serum. After washing in PBS-Tween, 200 1u of test serum was added to duplicate wells and the plate incubated for 2 hours at 37 'C. After further washing in PBS-Tween, captured antigen was identified by omniserum conjugated to alkaline phosphatase using the method described by Avreamas (15). After a final washing with PBS-Tween, captured conjugate was detected by incubation with the substrate tris(p-nitrophenyl) phosphate for 1 hour at 37 'C. The optimum conditions, sensitivity, and experimental variation of the test methods were established using purified pneumococcal polysaccharides as controls. The sensitivity of the assay ranged from 50 ng/ml (type 4, 8, 18, and 23 polysaccharides) to 2.5 ng/ml (type 3 polysaccharide). RESULTS Of the 64 patients with pneumonia in the study, 51 were less than 10 years of age. A bacterial etiology was established for a high proportion of both adults and children (Table 1). Lung aspiration was the most useful diagnostic procedure, and the lung aspirates from 29 of the 51 children (57%) were positive, as were those from 7 of the 13 older patients (54%) (Table 2). Blood cultures were positive for 14 children (27/o) and for 2 adults (15 %). The sera from only 6 of the 64 patients (9/o) were positive by CIE; however, 9 Nunc, Kamstrup, Roskilde, Denmark. Table 1. Relationship between age and the established bacterial etiology of pneumonia among patients in the study No. of patients Age group With positive (years) Total bacteriological diagnosis < (73) (56) (67) (75) (100) (50) (40) > (75) Total (67) Figures in parentheses represent percentages.
3 LOBAR PNEUMONIA IN THE GAMBIA 555 Table 2. Efficacy of diagnostic procedures in establishing a bacterial cause of pneumonia among patients, by age group, in the study No. of patients aged Procedure <10 years 10 years Total Culture of lung aspirate only Culture of blood only Culture of lung aspirate and blood CIE of serum alone' Total diagnosed Total studied a Countercurrent immunoelectrophoresis. for 2 patients this was the only way of diagnosing pneumococcal disease, and antigen was detected by this method in the sera of 2 of the 6 culture-positive cases of H. influenzae type b infection. Eighteen sera, 10 from patients with cultureproven pneumococcal pneumonia and 8 from undiagnosed patients, were tested for S. pneumoniae antigen by enzyme-linked immunosorbent assay (ELISA); 8 of the culture-proven and 3 of the undiagnosed cases were positive. Patients who were Table 3. Distribution of bacterial etiology in 43 of 64 patients, by age group, in the study No. of patients aged Bacterial etiology <10 years 10 years Total Streptococcus pneumoniae alone Haemophilus influenzae alone S. pneumoniae and H. influenzae S. pneumoniae, H. influenzae, and Branhamella catarrhalis Staphylococcus aureus No diagnosis Total Table 4. Distribution of serotypes of Streptococcus pneumoniae isolated from patients in the study Serotype No. of isolates 14,19, 46 2 each 2, 8, 18, 22, 23, 32 1 each positive only by ELISA were not included with the proven cases. Only 2 of the 8 sera from patients with culture-proven pneumococcal pneumonia that were positive by ELISA were also positive by CIE. Ninetyseven of 100 control sera obtained from patients with no clinical evidence of pneumococcal pneumonia were negative for S. pneumoniae antigen by ELISA, and the 3 positive sera came from patients with pronounced splenomegaly. Diagnoses For 43 of the 64 patients in the study the results obtained by at least one diagnostic procedure are shown in Table 3. S. pneumoniae and H. influenzae were the pathogens identified most frequently. S. pneumoniae was identified as an etiological agent in 34 of the 64 patients studied (53%) and in 34 of the 43 patients (79/e) for whom a bacterial etiology was made; for 29 of the latter patients it was the sole pathogen identified. For 21 patients the diagnosis was established only by lung aspiration. S. pneumoniae was the pathogen identified most frequently in patients of all age groups; however, there was no correlation between age and the likelihood of a positive blood culture. Twenty-eight pneumococcal isolates were serotyped and a further infection was serotyped by direct CIE of serum (Table 4). Type-5 S. pneumoniae was identified most frequently. All patients with type-5 pneumococcal pneumonia presented from January to May 1983, but there was no geographical clustering of cases. Because of the small number of isolates studied, no statistical correlation between serotype and age can be made, but types 6, 19, and 46 were isolated only from children under 2 years of age. No serotype was overrepresented in isolates obtained from blood cultures. Antibiotic sensitivity patterns were determined for 28 pneumococcal isolates. Two type-5 isolates were resistant to both chloramphenicol (minimal inhibi-
4 556 R.A.WALLETAL. tory concentration (MIC), 16 mg/i) and tetracycline (MIC, 16 mg/i). These isolates were obtained from 2 patients admitted only 4 days apart. A further three isolates (type 6, 14, 23) were resistant to tetracycline (MIC, 8-16 mg/l) but not to chloramphenicol. All isolates were sensitive to penicillin (MIC, <0.12 mg/l), erythromycin, and co-trimoxazole. H. influenzae was isolated from 13 of the 64 patients (20%) and from 13 of 43 patients (30%) for whom a bacterial etiology was made. Isolation of H. influenzae was age-related, being isolated from 11 of 49 children under 5 years of age but from only 2 of 15 older patients. This difference was, however, not statistically significant. For eight patients H. influenzae was isolated alone, for a further three in association with S. pneumoniae, and for two others in association with S. pneumoniae and Branhamella catarrhalis. One of the last-mentioned patients, an infant of 4 months, died. Seven of the 13 isolates of H. influenzae were of serotype b, two were of serotype a, while four were non-capsulated. All four non-capsulated isolates were obtained by lung puncture alone, while four of the seven serotype-b isolates were obtained from blood. Eight of the nine capsulated isolates were of biotype 1 and one was of biotype 4. Two of the four non-capsulated isolates were of biotype 2, while one each was of biotype 3 and biotype 5, respectively. All H. influenzae isolates were,3-lactamase negative and sensitive to penicillin (MIC, mg/l), ampicillin, chloramphenicol, and co-trimoxazole. DISCUSSION The study confirmed that lung aspiration is the most sensitive technique for establishing a cultural diagnosis of bacterial pneumonia in patients with consolidation, although a combination of lung aspiration, blood culture, and determination of serum antigen was required to achieve maximum diagnostic yield. Although lung aspiration was not associated with any morbidity in the study, it can cause haemoptysis and pneumothorax (6, 9) and it should, therefore, only be used with patients who can be kept under close observation. A simpler and safer method is required if pneumonia is to be diagnosed among patients who are to be managed in the community. Detection of capsular polysaccharide antigens in sputum by simple immunological techniques, such as CIE or coagglutination, can be of diagnostic value for adults (2, 4) but is not applicable for children; furthermore, detection of antigen in serum using these simple immunological methods is too insensitive to be of diagnostic value (6). We have, therefore, explored the use of a more sensitive ELISA technique for detecting pneumococcal capsular polysaccharide antigens in the serum of patients with pneumonia, and preliminary results are encouraging. A high proportion of positive reactions was obtained for patients with culture-positive pneumococcal pneumonia; however, positive reactions, which were probably false positives, were obtained from three patients with splenomegaly and may have been caused by a rheumatoid factor binding to rabbit 'yglobulin. An ELISA assay may prove to be of value in diagnosing pneumococcal pneumonia in situations where lung aspiration is impracticable. S. pneumoniae and H. influenzae were isolated either alone or together from 34 of the 64 patients (53%) studied, confirming the importance of these bacteria as the predominant etiological agents of pneumonia in hospitalized patients in developing countries. As expected, H. influenzae was isolated more frequently from children than from adults. In the case of children our results are very similar to those obtained, also by lung aspiration, in a recent study of the etiology of pneumonia among children admitted to hospital in Papua New Guinea (9). B. catarrhalis, an organism of uncertain pathogenicity, was isolated by lung aspiration in conjunction with H. influenzae from children in both studies. S. pneumoniae was the most frequent cause of pneumonia associated with pulmonary consolidation in Gambian adults and children admitted to hospital, as reported previously in Nigeria (6, 14, 16). Type 5 was the predominant serotype, and pneumococci of this serotype have been recorded previously as important etiological agents of pneumococcal meningitis and pneumonia in Nigeria, Senegal, and the Gambia (17, 18) but are rare elsewhere, although the reason for this is not clear. Type 5 pneumococcal polysaccharide was not included in the original 14-valent pneumococcal polysaccharide vaccine but it is included in the new 23-valent replacement.h H. influenzae, either alone or in combination with S. pneumoniae was the second most important cause of pneumonia in the study sample. When H influenzae was isolated alone, all but one of the isolates were capsulated, and 75% of them were of serotype b. As has been reported in other studies, the majority of isolates of this serotype were of biotype 1 (19). Two isolates of H. influenzae serotype a were obtained by lung aspiration and, in a subsequent study of invasive H. influenzae infection in Gambia, a further three isolates of type-a H. influenzae were obtained from patients with pneumonia and two from patients with meningitis (R. A. Wall, unpublished data). Type-a H. influenzae has been associated with paranasal sinusitis (20), but only occasionally with invasive disease in industrialized countries (21). In Papua New Guinea, only 19% of the isolates h Merck, Sharp & Dohme, Hoddesdon, Hertfordshire, England.
5 LOBAR PNEUMONIA IN THE GAMBIA 557 of H. influenzae obtained from children with pneumonia were of serotype b, the remainder being either other serotypes or non-typable. Thus, in developing countries non-type-b H. influenzae may be an important cause of pneumonia and other invasive diseases. The overall mortality of patients in our study was only 3%, but children with post-measles pneumonia and severe malnutrition were excluded, because of the higher morbidity from lung aspiration among them. Nevertheless, the overall mortality among the 207 patients with pneumonia admitted to the hospital during the study period was only 5%. This figure probably reflects the ease of access of patients in Banjul and its environs to medical care, and is probably not representative of the situation in the country as a whole. All isolates of S. pneumoniae and H. influenzae were sensitive to penicillin, which can thus be used safely to treat pneumonia in Gambian patients of all ages. The patients included in our study were highly selected in that they were sufficiently ill to warrant admission to a busy hospital and because they had clinical or radiological signs of pulmonary consolidation. Analysis of outpatient diagnoses over a 1-year period in the hospital revealed that 214 adults and 648 children were treated for pneumonia: there were clinical signs of pulmonary consolidation among 73% of the adults and 44% of the children. The etiology of pneumonia in those patients who exhibited no evidence of consolidation has not yet been established. ACKNOWLEDGEMENTS We wish to thank I. Blakebrough, Fa'Ansou Gassama, E. Golightly, I. McRobbie, and K. Williams for their expert technical assistance; the medical and nursing staff of the MRC Unit Fajara for their clinical help; and Janice Sparks for her excellent secretarial work. This study was supported by the Medical Research Council, London, England. RtSUMt ETIOLOGIE DE LA PNEUMONIE LOBAIRE EN GAMBIE Soixante-quatre cas de pneumonie lobaire aigue hospitalis6s en Gambie (Afrique de l'ouest) ont fait l'objet d'une etude. L'aspiration s'est revelee la technique la plus efficace pour la determination d'une etiologie bacterienne et IF micro-organisme le plus souvent isolm, quel que soit l'age, a e Streptococcus pneumoniae. Chez l'enfant, Haemophilus influenzae, soit seul, soit associe a une autre bacterie, s'est avere une cause importante de pneumonie. Sur 13 isolements de H. influenzae, deux etaient du serotype a tandis que quatre autres etaient non encapsules. Tous les isolements de S. pneumoniae et de H. influenzae se sont montres sensibles a la penicilline. REFERENCES 1. WALSH, J. A. & WARREN, K. S. Selective primary health care, an interim strategy for disease control in developing countries. New England journal of medicine, 301: (1979). 2. MILLER, J. ET AL. Diagnosis of pneumococcal pneumonia by antigen detection in sputum. Journal of clinical microbiology, 7: (1978). 3. MACFARLANE, J. T. ET AL. Hospital study of adult community-acquired pneumonia. Lancet, 1: (1982). 4. KALIN, M. ET AL. Diagnosis of pneumococcal pneumonia by coagglutination and counterimmunoelectrophoresis of sputum samples. European journal of clinical microbiology, 1: (1982). 5. MIMICA, I. ET AL. Lung puncture in the aetiological diagnosis of pneumonia. American journal of diseases of childhood, 122: (1971). 6. SILVERMAN, M. ET AL. Diagnosis of acute bacterial pneumonia in Nigerian children. Archives of disease in childhood, 52: (1977). 7. FINLAND, M. Diagnostic lung puncture. Pediatrics, 44: (1969). 8. KLEIN, J. 0. Diagnostic lung puncture in the pneumonias of infants and children. Pediatrics, 44: (1969). 9. SHANN, F. ET AL. Etiology of pneumonia in children in Goroka Hospital, Papua New Guinea. Lancet, 2: (1984). 10. CONGENI, B. L. & NANKERVIS, G. A. Diagnosis of pneumonia by counterimmunoelectrophoresis of respiratory secretions. American journal of diseases of childhood, 132: (1978). 11. TURNER, R. B. ET AL. Counterimmunoelectrophoresis of urine for diagnosis of bacterial pneumonia in
6 558 R. A. WALLETAL. pediatric outpatients. Pediatrics, 71: (1983). 12. KAPLAN, S. L. & FEIGIN, R. D. Rapid identification of the invading microorganism. Pediatric clinics ofnorth America, 27: (1980). 13. KILIAN, M. A taxonomic study of the genus Haemophilus with the proposal of a new species. Journal of general microbiology, 93: 9-62 (1976). 14. TUGWELL, P. & GREENWOOD, B. M. Pneumococcal antigen in lobar pneumonia. Journal of clinical pathology, 28: (1975). 15. AVREAMAS, S. Coupling of enzymes to proteins with glutaraldehyde. Immunochemistry, 6: (1969). 16. MACFARLANE, J. T. ET AL. Mycoplasma pneumoniae and the aetiology of lobar pneumonia in northern Nigeria. Thorax, 34: (1979). 17. GREENWOOD, B. M. ET AL. Pneumococcal serotypes in West Africa. Lancet, 1: 360 (1980). 18. DENIS, F. A. ET AL. Etude multicentrique des s6rotypes de pneumocoques en Afrique. Bulletin of the World Health Organization, 61: (1983). 19. KILIAN, M. ET AL. Biochemical characteristics of 130 recent isolates from Haemophilus influenzae meningitis. Journal of clinical microbiology, 9: (1979). 20. HOLDAWAY, M. D. & TURK, D. C. Capsulated Haemophilus influenzae and respiratory tract disease. Lancet 1: (1967). 21. TURK, D. C. The pathogenicity of Haemophilus influenzae. Journal of medical microbiology, 18: 1-16 (1984).
Surveillance of invasive pneumococcal infection in Belgium National Reference Laboratory Start in 198 Laboratory Microbiology UH Leuven (prof. J. Vandepitte) Capsular type determination Antibiotic susceptibility
Journal of Clinical Pathology, 1978, 31, 1167-1171 Latex, counterimmunoelectrophoresis, and protein A co- in diagnosis of bacterial meningitis S. I. S. DIRKS-GO AND H. C. ZANEN From the Department of Bacteriology,
Pneumococcal vaccines Safety & Efficacy Prof. Rajesh Kumar, MD PGIMER School of Public Health Chandigarh Disclosure Slide X X I DO NOT have any significant or other financial relationships with industry
JOURNAL OF CLINICAL MICROBIOLOGY, Aug. 1984, p. 259-265 95-1137/84/8259-7$2./ Copyright C) 1984, American Society for Microbiology Vol. 2, No. 2 Detection of Neisseria meningitidis Group A, Haemophilus
Faculty Disclosure Stephen I. Pelton, MD Dr. Pelton has listed no financial interest/arrangement that would be considered a conflict of interest. Advances in the management of fever in infants 0 to 3 and
Summary of attempts to replicate Anne Hyman s dissertation results Following submission of a manuscript on the type specificity of the capsular polysaccharide of the swine pathogen Haemophilus parasuis
ORIGINAL ARTICLE Changes in the Distribution of Capsular Serotypes of Streptococcus pneumoniae Isolated from Adult Respiratory Specimens in Japan Hisashi Shoji 1, Masayuki Maeda 2, Tetsuro Shirakura 3,
Evaluation of Antibacterial Effect of Odor Eliminating Compounds Yuan Zeng, Bingyu Li, Anwar Kalalah, Sang-Jin Suh, and S.S. Ditchkoff Summary Antibiotic activity of ten commercially available odor eliminating
Serotype Replacement in Perspective Ron Dagan The Pediatric Infectious Disease Unit Soroka University Medical Center Ben-Gurion University Beer-Sheva, Israel Replacement in carriage Replacement in disease
Streptococcus pneumoniae Surveillance Report 2005 Oregon Active Bacterial Core Surveillance (ABCs) Office of Disease Prevention & Epidemiology Oregon Department of Human Services Updated: March 2007 Background
CUMULATIVE INVASIVE PNEUMOCOCCAL DISEASE CASE NUMBERS REPORTED BY THE GERMS-SA SURVEILLANCE PROGRAMME, 5 TO DATE GERMS-SA surveillance programme http://www.nicd.ac.za/?page=germs-sa&id=97 National, active,
INVASIVE PNEUMOCOCCAL DISEASE IN NEW ZEALAND, 2015 Prepared as part of a Ministry of Health contract for scientific services by Health Group Institute of Environmental Science and Research Limited June
EXPERIMENTAL PNEUMONIA IN MICE FOLLOWING THE INHALATION OF STREPTOCOCCUS H2EMOLYTICUS AND OF FRIEDLANDER'S BACILLUS. BY ERNEST G. STILLMAN, M.D., AND ARNOLD BRANCH, M.D. (From the Hospital of The Rockefeller
EDUCATIONAL COMMENTARY THROAT CULTURES LEARNING OUTCOMES Upon completion of this exercise, the participant should be able to: distinguish three types of hemolysis produced by bacterial colonies. discuss
Chapter 19 Pathogenic Gram-Positive Bacteria Staphylococcus & Streptococcus Staphylococcus Normal members of every human's microbiota Can be opportunistic pathogens Facultative anaerobes Cells occur in
Practical Applications of Immunology Chapter 18 I. Vaccines A. Definition A suspension of organisms or fractions of organisms that is used to induce immunity (immunologic memory). The mechanism of memory
Culture of Orthopaedic Infections Microbiology Testing in the Diagnosis of Prosthetic Joint Infections December 9, 2013 Raymond P. Podzorski, Ph.D., D(ABMM) Clinical Microbiologist ProHealth Care Laboratories
Splenectomy Vaccine Protocol PIDPIC 6.24.14 Rationale Spleen clears encapsulated bacteria and infected erythrocytes Serves as one of the largest lymphoid tissues where B cells are educated against encapsulated
Journal of Clinical Pathology, 1978, 31, 913-918 Isolation of Staphylococcus aureus from sputum in cystic fibrosis P. D. SPARHAM, D. I. LOBBAN, AND D. C. E. SPELLER From the Bacteriology Department, Bristol
JCM Accepts, published online ahead of print on September 00 J. Clin. Microbiol. doi:./jcm.00-0 Copyright 00, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights Reserved.
BACTERIAL MENINGITIS: A FIVE YEAR (2001-2005) RETROSPECTIVE STUDY AT UNIVERSITY MALAYA MEDICAL CENTer (UMMC), KUALA LUMPUR, MALAYSIA H Erleena Nur, I Jamaiah, M Rohela and V Nissapatorn Department of Parasitology,
Carbohydrate Based Vaccines READ (on the WEB SITE): Lindberg, A.A. 1999. Glycoprotein vaccines. Vaccine:S28 :S28-S36S36 Weintraub,, A. 2003. Immunology of bacterial polysaccharide antigens. Carbohydr..
Lecture Notes Chapter 16: Bacterial Pneumonia Objectives Explain the epidemiology Identify the common causes Explain the pathological changes in the lung Identify clinical features Explain the treatment
JCM Accepts, published online ahead of print on 6 May 2009 J. Clin. Microbiol. doi:10.1128/jcm.00397-09 Copyright 2009, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights
PNEUMONIA : PROMISE FULFILLED? Regina Berba MD FPSMID Objectives of Lecture Know the quality of current evidence based guidelines on immunization Appreciate the performance of pneumonia vaccines in terns
Unit II Problem 2 Microbiology Lab: Pneumonia - What are the steps needed to obtain a proper sputum specimen? You need the following: A wide-mouth labeled container. Gloves. Water. Mouth wash + tissues.
New Technique uses to Evaluate Cerebrospinal Fluid Lactic Acid as an Aid Differential Diagnosis of Bacterial and Viral Meningitis Mohammed Kadum Al-Araji College of Pharmacy, University of Al-Mustansiriyah
ISO Sensitivity Test Agar Code: KM1204 A semi-defined nutritionally rich sensitivity medium. It is composed of specially selected peptones with a small amount of glucose, solidified with a very pure agar
41 Pneumococcal Disease Epidemiology and Prevention Abstract: Streptococcus pneumonie is a major cause of morbidity and mortality in very young, high-risk adults and elderly population. It kills almost
APPLIED MICROBIOLOGY, Mar. 1968, p. 445-449 Copyright 1968 American Society for Microbiology Vol. 16, No. 3 Printed in U.S.A. Survival of Aerobic and Anaerobic Bacteria in Chicken Meat During Freeze-Dehydration,
IMMULEX S. PNEUMONIAE OMNI ImmuLex S. Pneumoniae OMNI For in vitro diagnostic use Application The ImmuLex S. pneumoniae Omni is a ready-touse latex test for detection of all 92 Streptococcus pneumoniae
THE SIGNIFICANCE OF LACTOSE FERMENTATION AND ITS RELATIONSHIP TO RESISTANCE IN KLEBSIELLA PNEUMONIAE VICTOR J. CABELLI' AND M. J. PICKETT Department of Bacteriology, University of California, Los Angeles,
Chapter 10 Respiratory System J00-J99 Presented by: Jesicca Andrews 1 Respiratory System 2 Respiratory Infections A respiratory infection cannot be assumed from a laboratory report alone; physician concurrence
Upper Respiratory Infections Mehreen Arshad, MD Assistant Professor Pediatric Infectious Diseases Duke University Disclosures None Objectives Know the common age- and season-specific causes of pharyngitis
BRONCHITIS DEFINITION Bronchitis is an inflammation of the bronchial tubes (or bronchi), which are the air passages that extend from the trachea into the small airways and alveoli. Triggers may be infectious
Epidemiol. Infect. (1993), 111, 109-119 109 Copyright 1993 Cambridge University Press Levels of anti-pneumococcal antibodies in young children in Papua New Guinea W. S. POMAT 1, T. A. SMITH 12, R. C. SANDERS
THE AGGLUTINATION OF HUMAN ERYTHROCYTES MODIFIED BY TREATMENT WITH NEWCASTLE DISEASE AND INFLUENZA VIRUS' ALFRED L. FLORMAN' Pediatric Service and Division of Bacteriology, The Mount Sinai Hospital, New
Environmental survival of Neisseria meningitidis Yih-Ling Tzeng, Emory University L.E. Martin, Emory University David Stephens, Emory University Journal Title: Epidemiology and Infection Volume: Volume
SEROLOGICAL TYPES OF ESCHERICHIA COLI IN ASSOCIATION WITH INFANTILE GASTROENTERITIS G. S. TAWIL AND S. EL KHOLY Department of Bacteriology, Faculty of Medicine, University of Ein Chams, Cairo, U. A. R.
Susan I. Gerber, MD Local Public Health Department Communicable diseases Environmental health Chronic diseases Emergency preparedness Special programs Public Health Reporting Ground Zero Local government
PART 2: Vaccination for special risk groups 2.1 Vaccination for Aboriginal and Torres Strait Islander people Aboriginal and Torres Strait Islander people historically had a very high burden of infectious
Name: ate: 1. How does a virus cause a person to develop a common cold? 3. Which of the following is one important difference between a virus and a bacterial cell? A. invades the host cell to reproduce.
1 Detailed Review Paper on Pneumococcal Conjugate Vaccine - presented to the WHO Strategic Advisory Group of Experts (SAGE) on Immunization, November 2006 SAGE pneumococcal conjugate vaccine working group
Charles Krasner, M.D. University of NV, Reno School of Medicine Sierra NV Veterans Affairs Medical Center Kathy Peters is a 63 y.o. patient that presents to your urgent care office today with a history
Medical Bacteriology- Lecture 6 Streptococci 1 Classification of Streptococci based on (1) - Hemolysis reactions on blood agar) (Brown in 1903) The type of hemolytic reaction on blood agar has long been
2016 Vaccine Preventable Disease Summary 12251 James Street Holland, MI 49424 www.miottawa.org/healthdata Prepared October 2017 2016 Summary of Vaccine Preventable Diseases (VPDs) Reported to Ottawa County
Changing Epidemiology of Bacterial Meningitis in the United States William R. Short, MD and Allan R. Tunkel, MD, PhD Address Department of Medicine, Medical College of Pennsylvania/Hahnemann University,
Microbiological Methods V-A- 1 PRESUMPTIVE AND CONFIRMATION TESTS PRINCIPLE SCOPE Enrichment and selective procedures are used to provide a reasonably sensitive, definitive and versatile means of qualitatively
Specimen Page 1 of 10 Source / Type of Specimen Culture and Sensitivities () Abscess aspirate, wound aspirate in sterile screw cap or swab in charcoal. Obtain anaerobic swab from lab. Pilonidal and perirectal
Creating a User Defined Pneumonia-Specific Syndrome in ESSENCE Preventive Medicine Directorate September 2016 0 Pneumonia-Specific Syndrome NMCPHC retrospective analyses suggest that surveillance using
Invasive Salmonellosis in Central Nigeria Stephen Obaro MD, MRCP, FWACP, FRCPCH, PhD, FAAP Professor of Pediatrics Director, International Pediatric Research University of Nebraska Medical Center Omaha,
Manitoba Health, Healthy Living and Seniors Manitoba Annual Immunization Surveillance Report, 2012 and 2013 January 1, 2012 to December 31, 2013 with 5-year average comparison (January 1, 2007 to December
Lower Respiratory Tract Infection - Clinical Diseases and etiologic agents -Sample Collection and transport -Direct Smear (interpretation and Report) -Culture methods (interpretation and Report) The culture
ISSN: 2319-7706 Volume 4 Number 8 (2015) pp. 763-769 http://www.ijcmas.com Original Research Article A Study of Prognosis and Outcome of Community Acquired Pneumonia in a Tertiary Care Centre Bhadra Reddy
Community Acquired Pneumonia Pediatric Ages 3 month to 18 years Clinical Practice Guideline MedStar Health Antibiotic Stewardship These guidelines are provided to assist physicians and other clinicians
Mt. San Antonio College Microbiology 22 Lab Schedule for Spring 2018 Tues/ Split Lab Sections ONLY Wk 1 Feb. 27 Orientation with Introductions & Safety Rules/Regulations March 1 Orientation with Pathogen
ASSESSING THE VALUE OF VACCINE BEYOND EFFICACY AND SAFETY Bradford D. Gessner, MD Agence de Médecine Preventive First Regional Dengue Symposium Rio de Janeiro, Brasil November 3-4, 2015 BURDEN CONCEPTS
Indian Journal of Basic and Applied Medical Research; December 2015: Vol.-5, Issue- 1, P. 766-770 766-771 Original article: Study of etiological factors and sensitivity pattern in CSOM Paresh Chavan, G
CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY, Mar. 2002, p. 358 365 Vol. 9, No. 2 1071-412X/02/$04.00 0 DOI: 10.1128/CDLI.9.2.358 365.2002 Copyright 2002, American Society for Microbiology. All Rights
Disclosure The New PIDS-IDSA Community Acquired Pneumonia Guidelines Ricardo Quiñonez, MD, FAAP, FHM Section of Pediatric Hospital Medicine Baylor College of Medicine Texas Children s Hospital I have no
Use of simple clinical signs to predict pneumonia in young Gambian children: the influence of malnutrition A.G. Falade,1 H. Tschappeler,2 B.M. Greenwood,1 & E.K. Mulholland1 The current WHO recommendations
Fever in the Newborn Period 1. Definitions 1 2. Overview 1 3. History and Physical Examination 2 4. Fever in Infants Less than 3 Months Old 2 a. Table 1: Rochester criteria for low risk infants 3 5. Fever
TB & HIV CO-INFECTION IN CHILDREN Reené Naidoo Paediatric Infectious Diseases Broadreach Healthcare 19 April 2012 Introduction TB & HIV are two of the leading causes of morbidity & mortality in children
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
The microbial diagnosis of infective endocarditis (IE) Pierrette Melin Medical Microbiology pm-chulg sbimc 10.05.2007 1 Introduction for diagnosis Review of microbiological investigation of IE and perspectives
The microbial diagnosis of infective endocarditis (IE) Pierrette Melin Medical Microbiology pm-chulg sbimc 10.05.2007 1 Introduction for diagnosis Review of microbiological investigation of IE and perspectives
STUDIES ON THE ACTION OF WETTING AGENTS ON MICROORGANISMS I. THE EFFECT OF ph AIM WETTING AGENTS ON THE GERMICIDAL ACTION OF PHENOLIC COMPOUNDS E. J. ORDAL, J. L. WILSON,1 ANi A. F. BORG Laboratories of
Upper Respiratory Tract Infections Return to Syllabus INTRODUCTION TO UPPER RESPIRATORY TRACT DISEASES General Goal: To know the major mechanisms of defense in the URT, the major mechanisms invaders use
T e c h n i c a l S e m i n a r s Acute Respiratory Infections Sensivity & specificity Definition Pneumonia Recognition Fast breathing Antibiotics Severe Pneumonia or Very Severe Disease Lower chest wall
SURVEILLANCE REPORT Annual Epidemiological Report for 2015 Healthcare-associated infections acquired in intensive care units Key facts In 2015, 11 788 (8.3%) of patients staying in an intensive care unit
BioMed Research International Volume 2016, Article ID 6950482, 7 pages http://dx.doi.org/10.1155/2016/6950482 Research Article Serotype Distribution and Antimicrobial Resistance of Streptococcus pneumoniae
APPTED MICROBIOLOGY, Aug. 1969, p. 214-22 VoL 18, No. 2 Copyright 1969 American Society for Microbiology Printed in U.S.A. Quantitation of Microorganisms in Sputum P. W. MONROE, H. G. MUCHMORE, F. G. FELTON,
International Journal of Otolaryngology Volume 2012, Article ID 312935, 15 pages doi:10.1155/2012/312935 Review Article Pneumococcal Conjugate Vaccines and Otitis Media: An Appraisal of the Clinical Trials
A helping hand for your research Product Manual Human Apolipoprotein A1 EIA Kit Catalog Number: 83901 96 assays 1 Table of Content Product Description 3 Assay Principle 3 Kit Components 3 Storage 4 Reagent