Differentiation of bacterial and non-bacterial community-acquired pneumonia by thin-section computed tomography

Ito, Isao; Ishida, Tadashi; Togashi, Kaori; Koyama, Hiroshi; Ishimori, Takayoshi; Kobayashi, Hisataka; Mishima, Michiaki

doi:10.1016/j.ejrad.2008.08.004

Cited by 29 publications

(22 citation statements)

References 16 publications

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“…One prospective study of community-acquired pneumonia demonstrated that thin-section CT could differentiate bacterial pneumonia from nonbacterial lung disease with reasonable accuracy but only in patients without underlying lung disease. 19 Therefore, we think CT should not be recommended for initial evaluation of patients with pneumonia because of radiation exposure, although CT can be helpful in complicated cases to characterize overlapped pneumonia, to look for complications, or to detect underlying diseases in the lungs and mediastinum.…”

Section: Discussionmentioning

confidence: 98%

Correlations between computed tomography findings and clinical manifestations of Streptococcus pneumoniae pneumonia

et al. 2011

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Section: Discussionmentioning

confidence: 98%

Correlations between computed tomography findings and clinical manifestations of Streptococcus pneumoniae pneumonia

et al. 2011

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“…More minute findings can be recognized on chest CT, which can help to differentiate the pathogens that cause pneumonia. In addition, chest CT can confirm the existence of cavitations or other complications (5,8).…”

Section: Discussionmentioning

confidence: 99%

“…Unlike chest radiography, chest CT provides cross-sectional images; therefore, the pattern of pulmonary pathology distribution can be appreciated more readily with chest CT than with conventional radiology (6,7). It has been reported that there are few characteristic features indicative of causative organisms (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Computed Tomography Findings in 39 Cases of <i>Streptococcus pneumoniae</i> Pneumonia

et al. 2012

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Objective The main objective of our study was to describe the pulmonary distribution of consolidation and ground-glass opacity (GGO) in chest computed tomography (CT) scans of Streptococcus pneumoniae pneumonia. In addition, the percentage of other pulmonary abnormalities was also reported. Methods We retrospectively evaluated chest CT examinations performed between November 2008 and January 2010 in 39 patients with S. pneumoniae pneumonia. Eight patients with Haemophilus influenzae pneumonia were also included for comparison. Patients There were 19 women and 28 men with clinical symptoms of fever and productive cough and laboratory findings of leukocytosis with markedly high C-reactive protein levels. Chest X-ray scores before and after treatment were calculated. The average score before treatment was 4. The average score after treatment was 0. Parenchymal abnormalities were evaluated along with the presence of enlarged lymph nodes and pleural effusions. The distribution of parenchymal disease was also analyzed. Results The chest CT findings in the patients with S. pneumoniae pneumonia consisted primarily of consolidation (56.4%), ground-glass opacity (71.7%), interlobular reticular opacity (69.2%), centrilobular nodules (53.8%), interlobular septal thickening (46.6%), bronchial wall thickening (46.6%), lymph node enlargement (10.2%) and pleural effusion (10.2%). Segmental distribution (65.7%) was seen more frequently than nonsegmental distribution (35.9%). Abnormal findings were noticed bilaterally in 14 patients and unilaterally in 25 patients. On both the right and left sides, predominant zonal distributions were seen in the lower lobes. In contrast, among the eight patients with H. influenzae pneumonia, one patient had both segmental and nonsegmental distributions and the remaining seven patients had only segmental distributions. Conclusion In conclusion, segmental distributions of parenchymal abnormalities are more common than non-segmental distributions on chest CT scans of patients with S. pneumoniae pneumonia.

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“…No significant differences were observed between MS patients and MR patients. When we judged M. pneumoniae pneumonia as showing radiographic features with the combination of bronchial wall thickening and centrilobular nodules and/or ground-glass attenuation with lobular distribution (15,16), the diagnostically significant findings for suspecting M. pneumoniae pneumonia were found in 69% of MS patients and 70% of MR patients.…”

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confidence: 99%

Macrolide-Resistant Mycoplasma pneumoniae Pneumonia in Adolescents and Adults: Clinical Findings, Drug Susceptibility, and Therapeutic Efficacy

Miyashita

Akaike

Teranishi

et al. 2013

Antimicrob Agents Chemother

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We investigated differences in the clinical findings between 30 patients with macrolide-resistant Mycoplasma pneumoniae pneumonia and 43 patients with macrolide-sensitive M. pneumoniae pneumonia in adolescents and adults. No differences in clinical presentation were observed between the two groups. Among patients with macrolide-resistant Mycoplasma pneumoniae pneumonia, treatment was more effective in the groups that received quinolones and minocycline than in the group that received macrolides (P ‫؍‬ 0.0361 and P ‫؍‬ 0.0237, respectively). Mycoplasma pneumoniae is a major cause of community-acquired pneumonia (CAP) in school-age children and young adults (1, 2). A specific diagnosis of M. pneumoniae infection is important because treatment with routinely used ␤-lactam antibiotics is ineffective against these organisms because they lack a cell wall. Thus, the Japanese Respiratory Society (JRS) CAP guidelines have been recommended as a rapid and simple scoring system based on clinical and laboratory findings for the presumptive diagnosis of M. pneumoniae pneumonia (1,3,4). Our recent study demonstrated that the JRS scoring system was the most useful tool for initiating the administration of adequate antibiotic therapy for probable M. pneumoniae pneumonia among the rapid diagnostic methods tested (5).Although M. pneumoniae pneumonia is usually mild in severity, macrolide-resistant (MR) M. pneumoniae with mutations in the 23S rRNA gene has emerged in pediatric patients with CAP (6, 7). More than 60% of M. pneumoniae strains in pediatric patients showed high resistance to 14-and 15-membered ring macrolides with a MIC of Ն64 mg/liter (8-10). The clinical and bacteriological efficacy of macrolides for treating cases of MR M. pneumoniae pneumonia was lower than that in cases of macrolide-sensitive (MS) M. pneumoniae pneumonia in pediatric patients (9-13). In contrast to pediatric patients, the available data on MR M. pneumoniae infection in adolescent and adult patients are limited (8,14). The purpose of the present study was to identify a means of rapidly distinguishing MR M. pneumoniae pneumonia from MS M. pneumoniae pneumonia in daily clinical practice without waiting for genetic analysis results. We compared the underlying conditions, pneumonia severity, clinical symptoms, laboratory data, prognostic factors, and radiographic findings between patients with MR M. pneumoniae pneumonia and those with MS M. pneumoniae pneumonia (MR patients and MS patients, respectively) in adolescents and adults. Based on the clinical presentation, we evaluated the usefulness of rapid and simple clinical diagnostic methods (5), the JRS scoring system (1, 3, 4), and high-resolution computed tomography (HRCT) (15, 16) for the early presumptive diagnosis of M. pneumoniae pneumonia. An additional purpose of this study was to investigate the drug susceptibility of MR isolates and differences in therapeutic efficacy against MR M. pneumoniae among macrolides, quinolones, and minocycline.Adolescent and adult patients with CAP who visited 12 i...

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Differentiation of bacterial and non-bacterial community-acquired pneumonia by thin-section computed tomography

Cited by 29 publications

References 16 publications

Correlations between computed tomography findings and clinical manifestations of Streptococcus pneumoniae pneumonia

Correlations between computed tomography findings and clinical manifestations of Streptococcus pneumoniae pneumonia

Pulmonary Computed Tomography Findings in 39 Cases of <i>Streptococcus pneumoniae</i> Pneumonia

Macrolide-Resistant Mycoplasma pneumoniae Pneumonia in Adolescents and Adults: Clinical Findings, Drug Susceptibility, and Therapeutic Efficacy

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