Chest
Volume 101, Issue 2, February 1992, Pages 442-446
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Clinical Investigations
A Prospective Study of Community-Acquired Pneumonia in Hong Kong

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A prospective study of community-acquired pneumonia in Hong Kong was carried out between January and December, 1988. Ninety adults (57 male) with a mean age of 57.3 years were admitted to the Prince of Wales Hospital with community-acquired pneumonia. The etiologic diagnosis of pneumonia was made in 37 cases (41 percent). Pneumococcal infection was diagnosed in 11 patients (12 percent). The same number of patients had pulmonary tuberculosis presenting as acute pneumonia. It could not be differentiated from other causes of pneumonia on clinical and radiologic grounds, although pleural effusion and upper lobe involvement were more common in patients with tuberculosis. Chlamydia species were identified in five patients (6 percent) and Mycoplasma pneumoniae was identified in three patients (3 percent). There was no case of Legionnaires' disease. The etiologic agent could not be identified in 59 percent of cases. The low incidence of etiologic diagnosis of community-acquired pneumonia was probably related to the widespread use of antibiotics in private practice. Tuberculosis is an important cause of community-acquired pneumonia in Hong Kong and this diagnosis should be considered in patients who fail to respond to first-line antibiotics.

Section snippets

Patients

Between January 1, 1988 and December 31, 1988, all cases of community-acquired pneumonia in adults requiring admission to the Prince of Wales Hospital were considered for inclusion in the study. All patients had clinical features of acute lower respiratory tract infection and radiologic evidence of consolidation or shadowing suggestive of infection. The following were criteria for exclusion: (1) pneumonia distal to a bronchial obstruction due to a foreign body or carcinoma; (2) patients with

RESULTS

Forty-five definite or probable infective agents were detected in 37 patients (41 percent) (Table 1).

The bacterial pathogen most commonly identified was Streptococcus pneumoniae (11 patients). The diagnosis of pneumococcal infection was definite in four patients: one had a positive blood culture (the only positive blood culture in the whole study), and pneumococcal antigen was detected in the urine of three others. The diagnosis of pneumococcal infection was probable in seven patients: the

DISCUSSION

In this study, we were able to identify the pathogenic organism in 37 patients only (41 percent). This is lower than that reported in other countries with results ranging from 49 percent to 97 percent.3, 4 The percentage of pneumococcal pneumonia in our group of patients was 12.2 percent. This was much lower than studies from other countries that revealed S pneumoniae as the pathogen in 15 to 76 percent of cases.1, 2, 4, 5, 6, 7 The only exception was a report from the United Kingdom that

ACKNOWLEDGMENTS

We would like to thank the Microbiology Department of the Prince of Wales Hospital for technical support for this study.

REFERENCES (17)

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