[Nursing-home-acquired pneumococcal pneumonia--comparison of sputum cultures with Binax NOW Streptococcus pneumoniae urinary antigen assay].

To clarify the clinical significance of Pneumococcal pneumonia in nursing-home-acquired pneumonia, we examined the positive disease rate of using sputum cultures and the Binax NOW Streptococcus pneumoniae urinary antigen assay in 154 nursing-home patients with pneumonia. These included 54 males and 100 females with a mean age of 86.2 years. Bacteriological findings for sputum culture in 130 patients showed Streptococcus pneumoniae to be cultured in 11 cases (8%). In 72 in whom the Streptococcus pneumoniae-urinary antigen test (Binax NOW) was done, the urinary-antigen-positive rate (26/72 ; 36%) was higher than the culture positive rate for S. pneumoniae. Both examinations were done in 64 patients, among whom 5 in whom S. pneumoniae was cultured also had positive results for the urinary antigen test. Almost half of those undergoing percutaneous endoscopic gastroscopy (PEG) tube nutrition had positive results for the urinary antigen test, but not all such patients had positive cultures for S. pneumoniae. Although the culture-positive rate for S. pneumoniae in sputum was low, we concluded that S. pneumoniae was frequently linked to nursing-home-acquired pneumonia, especially in "total-care" patients.

Clinical characteristics of 8 sporadic cases of community-acquired Legionella pneumonia in advanced age.

Legionella spp are well recognized as one of the etiologic factor in pneumonia, but it is difficult to distinguish the clinical features of Legionella infection from pneumonia due to other causes. The objective of the present study was to examine the clinical characteristics of community-acquired Legionella pneumonia in elderly patients. We reviewed the clinical, laboratory and radiographic findings in 8 patients diagnosed as having pneumonia caused by Legionella. The diagnosis was confirmed by the presence of urinary antigen, bacterial culture, polymerase chain reaction (PCR) and serum antibody. There were 6 men and 2 women, whose ages ranged from 76 to 85 years. All patients had fever and hypoxia, four patients had respiratory symptoms. The initial chest X-ray findings were varied--consolidation, ground glass opacity, pleural effusion and linear shadow. Urinary antigen was positive in 4 patients, bacterial culture in 2, PCR on the sputum in 3 and serum antibody in 2 patients. As pneumonia caused by Legionella often becomes life-threatening, especially in elderly people, it is imperative to diagnose it at the initial stage. In this study, urinary antigen proved to be the most useful diagnostic means. However, it is important to confirm the diagnosis through plural examinations.