TYPE III PNEUMONIA: THE PROGNOSTIC SIGNIFICANCE OF RETICULATION IN RELATION TO THE NUMBER OF PNEUMOCOCCI IN THE SPUTUM, THERAPY, BACTEREMIA, LEUKOCYTE COUNT, AGE, AND DEGREE OF INVOLVEMENT 1

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Abstract
The Type III pneumococcus differs from all other pneumococci in its capacity to produce excessive amts. of capsular polysaccharide as manifested by a fibrin-like reticulum in Wright-stained smears of rusty sputum. In the present study of 114 cases of Type III pneumonia, reticulation in the sputum was by far the most important factor in determining the outcome. Thus the fatality rate was 79% when reticulation was present and only 7% when it was absent. Furthermore, the fatality in reticulated cases was uniformly high, regardless of the number of pneumococci in the sputum, the blood culture, leukocyte count, and the extent of the consolidation, but it was partially influenced by the factor of age. The unfavorable prognostic significance customarily attached to bacteremia and leuko-penia in Type III pneumonia was attributable to the fact that reticulation was almost invariably present in such cases. The outcome in the non-reticulated cases, as in the other types, was dependent upon the number of pneumococci per field in the sputum. Sulfapyridine and sulfathiazole were superior to serum and sulfanilamide in the treatment of Type III pneumonia because they prevented the formation of reticulation, and reduced the fatality rate in reticulated cases from 100% to 67%.

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