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Community-acquired pneumonia in southeast Asia: the microbial differences between ambulatory and hospitalized
Anan Wattanathum1, Chutima Chaoprasong, Pongpun Nunthapisud
1Division of Pulmonary, Phramongkutklao Hospital, Bangkok, Thailand. wattanathum@hotmail.com
Study Objectives:
To determine microbial agents causing community-acquired pneumonia (CAP) in Southeast Asia.
Design:
A prospective study.
Setting:
Three general hospitals in Thailand.
Patients:
Two hundred forty-five adult patients fulfilling the clinical criteria of CAP from September 1998 to April 2001.
Interventions:
Investigations included sputum Gram stain and culture, blood culture, pleural fluid culture (if presented), urine antigen for Legionella pneumophila and Streptococcus pneumoniae, and serology for Mycoplasma pneumoniae, Chlamydia pneumoniae, and L pneumophila.
Results:
There were 98 outpatients and 147 hospitalized patients included in the study, and an organism was identified in 74 of 98 outpatients (75.5%) and 105 of 147 of the hospitalized patients (71.4%). C pneumoniae (36.7%), M pneumoniae (29.6%), and S pneumoniae (13.3%) were the most frequent causative pathogens found in outpatients, while S pneumoniae (22.4%) and C pneumoniae (16.3%) were the most common in hospitalized patients. There was a significantly higher incidence of C pneumoniae (36.7% vs 16.3%, respectively; p < 0.001) and M pneumoniae (29.6% vs 6.8%; p < 0.001, respectively) in the outpatients than in the hospitalized patients. The incidence of S pneumoniae, L pneumophila, and mixed infections was not different between the groups. Mixed infections were presented in 13 of 98 outpatients (13.3%) and 9 of 147 hospitalized patients (6.1%), with C pneumoniae being the most frequent coinfecting pathogen.
Conclusions:
The data indicate that the core organisms causing CAP in Southeast Asia are not different from those in the Western countries. The guidelines for the treatment of patients with CAP, therefore, should be the same.
Insights
Community-acquired pneumonia (CAP) in Southeast Asia is caused by the same core pathogens as in Western countries, including Chlamydia pneumoniae and Mycoplasma pneumoniae. These findings suggest that current CAP treatment guidelines are applicable to this region.
Area of Science:
- Infectious Diseases
- Microbiology
- Pulmonology
Background:
- Community-acquired pneumonia (CAP) poses a significant public health challenge globally.
- Understanding the specific microbial etiology of CAP is crucial for effective treatment and prevention strategies.
- Regional variations in causative pathogens necessitate localized epidemiological studies.
Purpose of the Study:
- To identify the primary microbial agents responsible for community-acquired pneumonia (CAP) in Southeast Asia.
- To compare the etiological spectrum of CAP between outpatient and hospitalized patients in Thailand.
- To inform clinical management and public health policies for CAP in the region.
Main Methods:
- A prospective study was conducted involving 245 adult patients diagnosed with CAP across three general hospitals in Thailand.
- Diagnostic investigations included sputum and blood cultures, pleural fluid cultures, urinary antigen tests for Streptococcus pneumoniae and Legionella pneumophila, and serology for Mycoplasma pneumoniae and Chlamydia pneumoniae.
- Patients were categorized into outpatient and hospitalized groups for comparative analysis.
Main Results:
- Microbial agents were identified in 75.5% of outpatients and 71.4% of hospitalized patients.
- Chlamydia pneumoniae (36.7%) and Mycoplasma pneumoniae (29.6%) were the most prevalent pathogens in outpatients, while Streptococcus pneumoniae (22.4%) predominated in hospitalized patients.
- Higher incidences of C. pneumoniae and M. pneumoniae infections were observed in outpatients compared to hospitalized patients (p < 0.001 for both).
Conclusions:
- The etiological agents causing CAP in Southeast Asia are consistent with those identified in Western countries.
- The findings support the use of similar clinical guidelines for managing CAP patients in Southeast Asia as in Western regions.
- Further research may explore the impact of coinfections and specific pathogen prevalence on treatment outcomes.