Staphylococcal Pneumonia

STAPHYLOCOCCAI pneumonia is a well-recognised complication of epidemic influenza. Chickering and Park (1919) described 155 cases, and more recently 66 cases were recorded by Finland, Peterson, and Strauss (1942). Smaller series have also been reported, and both the virus influenza A and the staphylococcus were isolated from patients by Scadding (1937) and Michael (1942). It can also occur as a primary pneumonia or as a complication of staphylococcal pyaemia. This paper is based on fifteen cases of pneumonia, in whose sputa a coagulase-positive staphylococcus aureus was isolated in pure or almost pure culture. Only four of these occurred during an outbreak of influenza, Type A-prime, in Belfast in the months of January and February, 1951. The remaining eleven had, as far as we could ascertain, no connection with influenza. Primary staphylococcal pneumonia unassociated with influenza is usually reported as a disease of children. In them the mortality has been high. Kanof, et al. (1939), had a death rate of 65 per cent in twenty-three cases. Smaller series have been recorded with mortalities from 14 to 100 per cent. All our patients were adults, whose ages ranged from 21 to 74 years. The literature on cases which do not follow influenza is comparatively scanty. Reimann (1933) described six complicating various debili-tating conditions. Yet postvmortem reports on pneumonia suggest it may be commoner than is usually thought. Gaspar (1941) found staphylococci in 38 out of 144 autopsies on pneumonia in seven years. The prognosis in the various forms of staphylococcal pneumonia has shown considerable variation. The fulminating staphylococcal pneumonia following pandemic influenza carried an 82 per cent. mortality (Chickering and Park, 1919). Finland, Peterson, and Strauss (1942), using sulphonamides, had a mortality of 32 per cent. Brock (1945), in his thirty cases, had six deaths. Gibson and Belcher (1951) were able to describe ten cases associated with influenza treated with penicillin, all of which survived. In our series there was one death in hospital. This confirms the remarkable improvement in the prognosis following the introduction of antibiotics. The standard of the M.R.C. for the diagnosis of specific bacterial pneumonia is to find "the pathogenic bacteria on mouse inoculation, blood culture, culture of 27 K pleural fluid, or from the lung at autopsy; and in the case of staphylococcus aureus predominant only in the sputum, when this is clinically consistent and cultures from other sources are negative." Two main difficulties were found. It …