Clinical Studies on the Cold Agglutination Positive Pneumonia

From June 1955 to March 1961, 450 patients with so-called primary atypical pneumonia admitted the Department of Internal Medicine and the Pediatrics of National Chiba Hospital and 67 out of 150 patients indicated positive cold-agglutination reaction. Investigations were made on their epidemiology, clinical symptoms, laboratory findings as well as their prognosis. Results 1) The patients were 38 males and 29 females and they were found in their twenties. 2) Seasonal distribution-this disease occurs sporadically throughout the year, but more in fall and winter. The number of cases decreases markedly after spring of 1958. 3) Value of cold-agglutination reaction indicates 64 in many cases, it reaches highest in 1st-3rd week and then decreases gradually. 4) The disease develops gradually. Cough, expectration and fever are the main symptoms. However, no findings involving nose and throat of the patients were noted. Cheest physical findings are mild. 5) Blood picture-erythrocytes count normal. Leucocytes give normal or slightly increase, and half of the cases show increase of neutrophils and decrease of lymphocytes. These blood abnormalities all recover into normal by the end of 2 weeks after the outbreak of the disease. 6) The sedimentation rate is markedly elevated. Particularly the elevation is significant among the patients with severe clinical symptoms or high positive value of the coldagglutination reaction. The sedimentation rate returns to normal before the disappearance of the pulmonary densities. 7) Serum protein always normal. However, there are decrease of albumin, mild increase of alpha-globulin and gamma-globulin and normal beta-globulin. 8) Chest X-ray findings of radiating from hilus to periphery a diffuse and homogenous densities are noted in the lung field Particularly the densities are seen in the right middle or lower lobes. These abnormalities disappear within 30 days. 9) Recurrence of this type of pulmonary infiltration is rare and prognosis is good.