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Preliminary Reports |

Evaluation of the Polymerase Chain Reaction Method for Detection of Streptococcus pneumoniae DNA in Pleural Fluid Samples*

Miquel Falguera, MD; Aurora López, MD; Antoni Nogués, MD; José Manuel Porcel, MD, FCCP; Manuel Rubio-Caballero, MD
Author and Funding Information

*From the Departments of Internal Medicine (Drs. Falguera, López, Porcel, and Rubio-Caballero) and Microbiology (Dr. Nogués), Hospital Universitari Arnau de Vilanova, Lleida, Spain.

Correspondence to: Miquel Falguera, MD, Department of Internal Medicine, Hospital Universitari Arnau de Vilanova, Rovira Roure 80, 25198 Lleida, Spain; e-mail: mfalguera@comll.es



Chest. 2002;122(6):2212-2216. doi:10.1378/chest.122.6.2212
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Study objective: Streptococcus pneumoniae is the most frequent causative agent of community-acquired pneumonia (CAP); however, an etiologic diagnosis by traditional techniques can be accomplished in only a small percentage of patients with CAP. Pleural fluid is present in approximately 40% of patients with CAP; therefore, we hypothesized that detection of S pneumoniae DNA in pleural fluid by polymerase chain reaction (PCR) may help to increase the rate of diagnosis of pneumococcal pneumonia.

Design: A prospective study of cases.

Setting: A university hospital in Lleida, Spain.

Patients and methods: One hundred two samples of pleural fluid (51 samples from consecutive adult patients with pneumonia and 51 samples from unselected control subjects) were tested by the nested-PCR method to detect selected pneumolysin gene of S pneumoniae, and the results were compared with those provided by alternative diagnostic methods.

Results: PCR in pleural fluid had a diagnostic sensitivity of 78% in patients with pneumococcal pneumonia, with positive results in 2 of 2 patients (100%) and 5 of 7 patients (71%) who had positive or negative pleural fluid culture findings, respectively. PCR results were also positive in 3 of 24 patients (12%) with pneumonia of unknown etiology and negative in all patients with pneumonia due to microorganisms other than S pneumoniae. Thus, the calculated specificity was 93%. Among control subjects, PCR gave positive results in two cases (4%).

Conclusion: The nested-PCR test, applied to pleural fluid samples from patients with CAP, showed a sensitivity of 78% and a specificity of 93% in the diagnosis of pneumococcal pneumonia.


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