Diagnosis of XXXX .

@entity1 @entity66 @entity5414 @entity55 @entity2260 @entity3509 @entity693 @entity2028 @entity2258 @entity2259
@entity2258 presents peculiar problems to the diagnostician. It is at once the most common form of community-acquired @entity2028 and simultaneously the most difficult to document microbiologically. @entity2259 , @entity3509 , @entity693 , or @entity5414 due to @entity2260 unmistakably verifies this bacterium as the cause of a coexistent @entity55 ; this coexistence fortunately occurs infrequently. The diagnostic dilemma arises in the less sick @entity1 . While recognizing the common presence of pneumococci in the oropharynx of healthy individuals, we give undue credence to @entity2260 cultured from sputum obtained by expectoration. At the same time, pneumococci are frequently not found in cultures of sputum obtained from @entity1 with confirmed @entity66 . More invasive techniques (transtracheal aspiration, protected bronchoscopic catheter, lung needle aspiration) are too complex, dangerous, or both for routine use. Attempts to detect pneumococcal antigen in blood, sputum, or urine by modern immunologic techniques give promise of avoiding the problems of either contamination or lack of bacteriologic growth. However, they have not yet been evaluated in sufficiently large groups with @entity55 of independently determined bacterial etiology to calculate test sensitivity and specificity. At the present time then, the careful clinician will use all the epidemiologic and clinical evidence at hand, including a careful Gram's stain and culturing of sputum, blood, and other sources, to arrive at the most likely etiology. The probabilities must be weighed in light of the imprecision of current laboratory confirmation and modified by clinical course. Choice of antimicrobial therapy still favor penicillin for @entity1 with community @entity55 severe enough to warrant hospitalization, despite ominous trends in multiple resistance of @entity2260 .
