Quantitative Polymerase Chain Reaction for Improved Detection of Pneumococci in CAP "CAPTAIN"

Inclusion Criteria

• •Patients:
• •Age 18 years or above;
• •Presentation at the emergency department (ED);
• •Working diagnosis of CAP at the ED with the presence of at least two of the following criteria:
• •1. New or worsened coughing;
• •2. Production of purulent sputum or change in sputum colour;
• •3. Temperature \>38.0 ⁰C or ≤36.0 ⁰C (tympanic);
• •4. Auscultatory findings consistent with pneumonia, including rales, evidence of pulmonary consolidation (dullness on percussion, bronchial breath sounds, rales, or egophony), or both;
• •5. White blood cell count of \>10x10\^9 cells/L or \<4x10\^9 cells/L or \>15% bands;
• •6. C-reactive protein level ≥30mg/L;
• •7. Dyspnea, tachypnea, (\>20 breaths per minute), or hypoxemia (arterial pO2 \<60mmHg or peripheral O2 saturation \<90%).
• •New consolidation(s) on the chest radiograph or computed tomography (CT);
• •No other explanation for the signs and symptoms;
• •Control group 1 - Related controls
• •Being aged 18 years or above;
• •Close relative of the patient: relative defined as living in the same house as the CAP patient or daily contact;
• •Is at the hospital at the moment of inclusion of the CAP patient or is willing to come for testing within 7 days;
• •Control group 2 - Unrelated healthy individuals
• •Being aged 18 years or above;
• •Subject with a preoperative appointment with the anaesthiologist for a planned surgical procedure;
• •Age matched to a included CAP patient (+-10 years);
• •Time matched to a included CAP patient (up to 14 days after inclusion of the CAP patient);
• •Gender matched to a included CAP patient.
• •Control group 3 - Patients with stable COPD
• •Being aged 18 years or above;
• •Diagnosis of COPD confirmed with spirometry (GOLD criteria 2017)(76);
• •Stable disease.
• •Control group 4 - Patients with exacerbation of COPD
• •Being aged 18 years or above;
• •Diagnosis of COPD confirmed with spirometry (GOLD criteria 2017)(76);
• •Diagnosis of exacerbation of COPD: defined as an acute event characterised by a worsening of the patient's respiratory symptoms that is beyond normal day-to-day variations and leads to a change in medication (76).
• •Presentation at emergency department with the suspicion of an exacerbation.
• •Present or recent hospitalisation (14 days);
• •Use of antibiotics in the last 14 days, including maintenance antibiotic therapy.
• •Control group 1 and 2 - Related healthy controls and unrelated healthy individuals
• •Active infectious respiratory complaints defined as defined as two or more respiratory symptoms (cough, nasal congestion, runny nose, sore throat or sneezes);
• •Temperature \>38.0 ⁰C;
• •Chronic pulmonary disease: COPD, asthma, cystic fibrosis, bronchiectasis.
• •Control group 3 - Patients with stable COPD
• •Temperature \>38.0 ⁰C;
• •Stable disease;
• •Recent exacerbation (\<1 month) defined as increased respiratory symptoms with need of antibiotic and/or corticosteroid therapy;
• •History of cystic fibrosis.
• •Control group 4 - Patients with exacerbation of COPD
• •Current pneumonia;
• •Recent exacerbation (\<1 month) defined as increased respiratory symptoms with need of antibiotic and/or corticosteroid therapy;
• •History of cystic fibrosis.