0
Correspondence |

Absence of Atypical Pathogens in Pleural InfectionAbsence of Atypical Pathogens in Pleural Infection FREE TO VIEW

John M. Wrightson, DPhil; Jessica A. Wray, PhD; Teresa L. Street, PhD; Stephen J. Chapman, DM; Fergus V. Gleeson, MBBS; Nicholas A. Maskell, DM; Timothy E. A. Peto, DPhil; Najib M. Rahman, DPhil; Derrick W. M. Crook, MBBCh
Author and Funding Information

From the Oxford Pleural Unit (Drs Wrightson, Chapman, and Rahman and Prof Gleeson), Oxford Centre for Respiratory Medicine, Department of Thoracic Radiology (Prof Gleeson), and Oxford Respiratory Trials Unit (Dr Rahman), Churchill Hospital; NIHR Oxford Biomedical Research Centre (Drs Wrightson, Wray, Street, Chapman, and Rahman and Profs Gleeson, Peto, and Crook), University of Oxford; Department of Microbiology and Infectious Diseases (Dr Wrightson and Profs Peto and Crook), John Radcliffe Hospital; and North Bristol Lung Centre (Dr Maskell), Southmead Hospital, and Academic Respiratory Unit (Dr Maskell), Department of Clinical Sciences, Bristol University.

CORRESPONDENCE TO: John M. Wrightson, DPhil, Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Churchill Hospital, Old Rd, Oxford, OX3 7LJ, England; e-mail: johnwrightson@thorax.org.uk


Drs Wrightson and Wray are equally contributing joint first authors.

Some of the results of this study were reported in abstract form at the 2012 American Thoracic Society International Conference, May 18-23, 2012, San Francisco, CA.

FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(3):e102-e103. doi:10.1378/chest.15-1130
Text Size: A A A
Published online
To the Editor:

“Atypical” pneumonia organisms (ie, Legionella pneumophila, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Chlamydophila psittaci, and Coxiella burnetii) frequently cause community-acquired pneumonia, but their role in pleural infection is unknown because they are not detected by standard pleural fluid culture. Such knowledge could have relevance to empirical antibiotic choices and routine microbiology culture protocols.

Nucleic acid amplification testing (NAAT) of the 16S ribosomal RNA gene allows atypical detection with high sensitivity and specificity. Therefore, we undertook a 16S NAAT-based study to estimate the prevalence of atypical pathogens in pleural infection, either as a sole pathogen or in polymicrobial infection.

Pleural fluid from 374 patients with pleural infection (89% community acquired) from 52 centers in the United Kingdom, collected as part of two randomized controlled trials between 1999 and 2008,1,2 were analyzed. Further experimental details are found in e-Appendix 1. Nested polymerase chain reactions, initially targeting conserved regions of the 16S gene, common to all bacteria, and subsequently targeting genus-specific sequences, were used to detect atypical organisms. 16S sequencing was used to confirm species identity for any positive reactions.

Of the 374 samples tested, only two samples were positive using Mycoplasma species primers. Sequencing confirmed Mycoplasma salivarium in one and M salivarium/arthritidis in the other. M salivarium has been isolated in the oropharynx, particularly within the gingival crevices, and may play a role in periodontal disease.3 Its DNA has been isolated in synovial fluid of patients with arthritis4 and has also been found in polymicrobial brain abscesses.5M arthritidis has not been demonstrated to cause human disease and seems unlikely to be the implicated pathogen in the second case. There were two weak false-positive results using Coxiella species primers. No samples were positive for Legionella species or Chlamydophila species.

To our knowledge, this study presents the first systematic assessment for atypical pathogens by using highly sensitive NAAT in a patient group with pleural infection representative of routine clinical practice. In contrast to the 20% to 40% of cases of pneumonia caused by atypical pathogens, we found that atypical pathogens cause pleural infection very infrequently, lending further weight to the hypothesis that the bacteriology of pleural infection differs from that of pneumonia. There is no evidence that atypical coverage is required in the empirical antibiotics chosen for pleural infection. Furthermore, there is no requirement for specialist atypical culture during routine pleural fluid analysis.

Acknowledgments

Additional information: The e-Appendix can be found in the Supplemental Materials section of the online article.

Maskell NA, Davies CWH, Nunn AJ, et al; First Multicenter Intrapleural Sepsis Trial (MIST1) Group. UK controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005;352(9):865-874. [CrossRef] [PubMed]
 
Rahman NM, Maskell NA, West A, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011;365(6):518-526. [CrossRef] [PubMed]
 
Engel LD, Kenny GE. Mycoplasma salivariumin human gingival sulci. J Periodontal Res. 1970;5(3):163-171. [CrossRef] [PubMed]
 
Johnson SM, Bruckner F, Collins D. Distribution ofMycoplasma pneumoniaeandMycoplasma salivariumin the synovial fluid of arthritis patients. J Clin Microbiol. 2007;45(3):953-957. [CrossRef] [PubMed]
 
Ørsted I, Gertsen JB, Schønheyder HC, Jensen JS, Nielsen H. Mycoplasma salivariumisolated from brain abscesses. Clin Microbiol Infect. 2011;17(7):1047-1049. [CrossRef] [PubMed]
 

Figures

Tables

References

Maskell NA, Davies CWH, Nunn AJ, et al; First Multicenter Intrapleural Sepsis Trial (MIST1) Group. UK controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005;352(9):865-874. [CrossRef] [PubMed]
 
Rahman NM, Maskell NA, West A, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011;365(6):518-526. [CrossRef] [PubMed]
 
Engel LD, Kenny GE. Mycoplasma salivariumin human gingival sulci. J Periodontal Res. 1970;5(3):163-171. [CrossRef] [PubMed]
 
Johnson SM, Bruckner F, Collins D. Distribution ofMycoplasma pneumoniaeandMycoplasma salivariumin the synovial fluid of arthritis patients. J Clin Microbiol. 2007;45(3):953-957. [CrossRef] [PubMed]
 
Ørsted I, Gertsen JB, Schønheyder HC, Jensen JS, Nielsen H. Mycoplasma salivariumisolated from brain abscesses. Clin Microbiol Infect. 2011;17(7):1047-1049. [CrossRef] [PubMed]
 
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).
Supporting Data

Online Supplement

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.

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