PNEUMOCOCCIC PNEUMONIA: THE PROGNOSTIC SIGNIFICANCE OF THE NUMBER OF PNEUMOCOCCI IN THE SPUTUM IN RELATION TO THERAPY, BACTEREMIA, TYPE, LEUKOCYTE COUNT, DURATION OF THE DISEASE, AGE, AND DEGREE OF INVOLVEMENT 1
Open Access
- 1 March 1943
- journal article
- research article
- Published by American Society for Clinical Investigation in Journal of Clinical Investigation
- Vol. 22 (2) , 207-214
- https://doi.org/10.1172/jci101384
Abstract
The average number of pneumococci per oil-immersion field in Wright-stained smears of rusty sputum was determined at 12-hr. intervals in 678 cases of pneumococcic pneumonia, exclusive of Type III. The close relationship between the highest sputum count during the course of the disease, and the outcome, was shown by the fact that the fatality rate was 2% when the pneumococci did not exceed 10 per field, 9% when 11-30 were present, 30% when 31-75 organisms were found, and 77% when the number exceeded 75. The fatality rate was uniformly low in patients with < 30 pneumococci per field and uniformly high in those with sputum counts > 30 regardless of the type of pneumococcus, duration of the disease prior to therapy, leukocyte count, and blood culture. The unfavorable prognosis usually attributed to type, bacteremia, leukopenia, and late pneumonia, was due chiefly to the higher incidence of sputum counts > 30 per [center dot] field in such cases. Comparison of cases whose sputum counts fell within the same range showed that age and extent of consolidation had a definite effect upon the outcome since the fatality rate was significantly higher in patients over 54 or in those with consolidation of 2 or more lobes on admission to the hospital. Evidently the number of pneumococci in the sputum had the greatest influence on prognosis and the most important accessory factors were the extent of involvement and the age of the patient. Modern chemotherapeutic agents did not appreciably reduce the fatality rate in cases with sputum counts < 30, but were distinctly superior to sulfanilamide and serum in cases with counts > 30. The combination of serum and drugs appeared to be no more effective in the latter group than chemotherapy alone.This publication has 0 references indexed in Scilit: