0
Communications to the Editor |

Etiology of Community-Acquired Pneumonia Requiring Hospitalization in Japan FREE TO VIEW

Naoyuki Miyashita, MD, PhD; Hiroshi Fukano, MD; Yoshihito Niki, MD, PhD, FCCP; Toshiharu Matsushima, MD, PhD, FCCP; Niro Okimoto, MD, PhD, FCCP
Author and Funding Information

Kawasaki Medical School Kawasaki Hospital Okayama, Japan

Correspondence to: Naoyuki Miyashita, MD, PhD, Department of Internal Medicine, Kurashiki Daiichi Hospital, 5–3-10 Oimatsu cho, Kurashiki City, Okayama 710-0826, Japan; e-mail: nao@med.kawasaki-m.ac.jp



Chest. 2000;119(4):1295-1296. doi:10.1378/chest.119.4.1295-a
Text Size: A A A
Published online

To the Editor:

Community-acquired pneumonia (CAP) remains a common cause of morbidity. Because CAP also is a potentially fatal disease, even in previously healthy persons, early appropriate antibiotic treatment is vital. In Japan, pneumonia is the fourth leading cause of death, and from 57 to 70 persons per 100,000 population died per year of this disease in the last decade. Because of this high rate of morbidity, guidelines for CAP management have been produced in Japan.1However, prospective studies on the etiology of CAP among the Japanese population have been very limited, and only the etiology of CAP has been investigated by Ishida et al (December 1998).2 Therefore, we investigated the etiology of CAP requiring hospitalization in Japan based on our findings.

We undertook a study to determine the etiology of CAP in Japan between April 1998 and September 2000 at three different hospitals. The microbiological and serologic studies that were performed were almost the same as those used in the study by Ishida et al.2 In addition, we also employed other diagnostic methods for the detection of Chlamydia spp, Coxiella burnetii, and Legionella spp. Chlamydia pneumoniae, Chlamydia psittaci, and Chlamydia trachomatis infections were diagnosed by isolation in cell cultures and by serology. Antibodies to Chlamydia spp were measured by the microimmunofluorescence test, and cell cultures were performed in cycloheximide-treated HEp-2 and HeLa 229 cells. Antibodies to C burnetii were measured by the indirect immunofluorescence test. In addition to serology and culturing, the urinary antigen test was used for detection of Legionella spp.

Two hundred patients (128 men and 72 women; age range, 19 to 91 years; mean age, 60.9 years) who had had episodes of pneumonia were enrolled in the study. One hundred nine (54.5%) patients had at least one underlying disease. A microbiological diagnosis was established in 117 patients with pneumonia (58.5%). The most common pathogens were Streptococcus pneumoniae (41 patients [20.5%]), followed by Haemophilus influenzae (22 patients [11.0%]), Mycoplasma pneumoniae (19 patients [9.5%]), C pneumoniae (15 patients [7.5%]), and Staphylococcus aureus (10 patients [5.0%]) (Table 1 ). Dual pathogens were detected in 25 patients (12.5%).

Ishida et al2 investigated the etiology of CAP among the Japanese population for the first time, and their findings did not differ markedly when compared with those of Western countries. Our results were almost consistent with those of Ishida et al,2with the exception of the frequencies of atypical pathogens. The atypical pathogens, C pneumoniae, Legionella spp, C burnetii, and M pneumoniae, have been recognized as common respiratory pathogens. In several studies,6 these organisms have been found to account for up to 25% of CAP cases in Western countries. In the present study, we were able to detect atypical pathogens in approximately 20% of CAP cases. The frequencies were lower than those in Western countries but were higher than those in the study of Ishida et al.2 The difference from the study by Ishida et al may be related to the period in which the survey was conducted or to the traditional diagnostic methods used for the detection of C pneumoniae. The difference from findings in Western countries may be due to the low incidence of Legionella and C burnetii pneumonia in Japan.

In our study, S pneumoniae was the leading cause of CAP, and an emerging or newly recognized pathogen, C pneumoniae, was also a significant causative microorganism in Japan. The recognition of these results will allow us to treat patients with prompt antimicrobial therapy and will promote the formulation of new guidelines for the management of CAP in Japan.

Table Graphic Jump Location
Table 1. Microbiological Diagnosis of 200 Episodes of CAP*
* 

Patients with dual infections were included.

References

. The Japanese Respiratory Society (2000) Basic management of community-acquired pneumonia in adults Matsushima, T Kohno, S Saito, A eds.Guidelines for the management of respiratory tract infection,1-49 The Japanese Respiratory Society. Tokyo, Japan:
 
Ishida, T, Hashimoto, T, Arita, M, et al Etiology of community-acquired pneumonia in hospitalized patients: a 3-year prospective study in Japan.Chest1998;114,1588-1593. [CrossRef]
 
Woodhead, M Community-acquired pneumonia guidelines: an international comparison.Chest1998;113,S183-S187. [CrossRef]
 
Ortqvist, A, Valtonen, M, Cars, O, et al Oral empiric treatment of community- acquired pneumonia: a multicenter, double-blind, randomized study comparing sparfloxacin with roxithromycin.Chest1996;110,1499-1506. [CrossRef]
 
Liberman, D, Schlaeffer, F, Boldur, I, et al Multiple pathogens in adult patients admitted with community-acquired pneumonia: a 1-year prospective study of 346 consecutive patients.Thorax1996;51,179-184. [CrossRef]
 
Ruiz-Gonzalez, A, Falguera, M, Nogues, A, et al IsStreptococcus pneumoniaethe leading cause of pneumonia of unknown etiology? A microbiologic study of lung aspirates in consecutive patients with community-acquired pneumonia.Am J Med1999;106,385-390. [CrossRef]
 

Figures

Tables

Table Graphic Jump Location
Table 1. Microbiological Diagnosis of 200 Episodes of CAP*
* 

Patients with dual infections were included.

References

. The Japanese Respiratory Society (2000) Basic management of community-acquired pneumonia in adults Matsushima, T Kohno, S Saito, A eds.Guidelines for the management of respiratory tract infection,1-49 The Japanese Respiratory Society. Tokyo, Japan:
 
Ishida, T, Hashimoto, T, Arita, M, et al Etiology of community-acquired pneumonia in hospitalized patients: a 3-year prospective study in Japan.Chest1998;114,1588-1593. [CrossRef]
 
Woodhead, M Community-acquired pneumonia guidelines: an international comparison.Chest1998;113,S183-S187. [CrossRef]
 
Ortqvist, A, Valtonen, M, Cars, O, et al Oral empiric treatment of community- acquired pneumonia: a multicenter, double-blind, randomized study comparing sparfloxacin with roxithromycin.Chest1996;110,1499-1506. [CrossRef]
 
Liberman, D, Schlaeffer, F, Boldur, I, et al Multiple pathogens in adult patients admitted with community-acquired pneumonia: a 1-year prospective study of 346 consecutive patients.Thorax1996;51,179-184. [CrossRef]
 
Ruiz-Gonzalez, A, Falguera, M, Nogues, A, et al IsStreptococcus pneumoniaethe leading cause of pneumonia of unknown etiology? A microbiologic study of lung aspirates in consecutive patients with community-acquired pneumonia.Am J Med1999;106,385-390. [CrossRef]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543