Etiology and clinical study of community-acquired pneumonia in 157 hospitalized children

doi:10.1007/s10156-006-0476-5

Journal of Infection and Chemotherapy

Volume 12, Issue 6, 2006, Pages 372-379

https://doi.org/10.1007/s10156-006-0476-5 Get rights and content

Abstract

We tried to verify whether the currently employed diagnosis and treatment of community-acquired pneumonia in children were appropriate. For this purpose, we created tentative criteria for the classification of pediatric community-acquired pneumonia. We classified the community-acquired pneumonia into ten categories: (1) bacterial, (2) concomitant viral-bacterial, (3) viral, (4) mycoplasmal, (5) concomitant mycoplasmal-bacterial, (6) concomitant mycoplasmal-viral, (7) chlamydial, (8) concomitant chlamydial-bacterial, (9) concomitant chlamydial-viral, and (10) unknown. Children aged 1 month to 13 years with radiographic and clinical evidence of pneumonia were enrolled. Between October 2001 and September 2002, we enrolled 165 patients. The etiologic agents were determined in 126 of the 157 (80.3%) patients who were finally diagnosed with pneumonia. Two blood cultures were positive for Haemophilus influenzae type b and Streptococcus pneumoniae. A viral infection alone was found in 28 of the 157 patients (17.8%), a bacterial (without mycoplasmal) alone infection in 42 (26.8%), a concomitant viral-bacterial infection in 28 (17.8%), and a mycoplasmal infection in 27 (17.2%) patients. RS virus was identified in 28 patients (17.8%), influenza A in 12 (7.6%), parainfluenza 3 in 8 (5.1%), adenovirus in 8 (5.1%), and influenza B and measles virus in 1 patient each. Streptococcus pneumoniae was the most common cause of bacterial pneumonia. We chose the initial treatment according to clinical and laboratory findings on admission (i.e., patients' age, clinical course, chest X-ray, and laboratory findings). In 68 of the 71 patients with bacterial (without mycoplasmal) pneumonia, an appropriate antibacterial-agent was prescribed. In 25 of the 27 patients with mycoplasmal pneumonia, clindamycin and minocycline were prescribed.

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2023, Journal of Microbiology, Immunology and Infection
The usefulness of an induced sputum in the identification of causative bacteria of community-acquired pneumonia (CAP) in young children is controversial. This study aimed to investigate the significance of the implementation of an induced sputum culture among children with CAP and the impact of prior use of antimicrobial agents on the quality of the sample and result of the culture.
This prospective study included 96 children hospitalized for acute bacterial CAP whose sputum samples were collected by suctioning from the hypopharynx through the nose. The samples were evaluated for their quality using Geckler classification, and the result of this conventional culture method was compared to that of a clone library analysis of the bacterial 16S rRNA gene sequence for each sample.
The concordance between bacteria isolated by sputum culture and the most predominant bacteria identified by a clonal library analysis was significantly higher in the samples judged as a good quality (Geckler 5, 90%) than in others (70%). The rate of good-quality sputum sample was significantly higher in samples collected from patients without prior antimicrobial therapy (70%) than in those from patients with it (41%). The concordance between the two methods was significantly higher in the former (88%) than in the latter population (71%).
Bacteria isolated by the culture using good-quality sputum samples collected from children with CAP were more likely to be causative pathogens. Sputum samples collected before starting antimicrobial therapy showed better quality and higher probability of the identification of causative pathogens.
The utility of biomarkers in differentiating bacterial from non-bacterial lower respiratory tract infection in hospitalized children: Difference of the diagnostic performance between acute pneumonia and bronchitis
2014, Journal of Infection and Chemotherapy
Citation Excerpt :
Community-acquired lower respiratory tract infection (CA-LRTI) is one of the most common diseases in children. Causative pathogens of CA-LRTI are mainly bacteria and virus, and frequent occurrence of bacterial infection is confirmed in children hospitalized for pneumonia [1,2]. Appropriate antimicrobial therapy following early differentiation of bacterial infection has been recommended in the patients diagnosed as pneumonia [1,3].
The aim of this study is to investigate the utility of several biomarkers in differentiating bacterial community-acquired lower respiratory tract infection (CA-LRTI) from non-bacterial CA-LRTI in children and the difference of their diagnostic performance between pneumonia and bronchitis. A retrospective cohort study composed of 108 pediatric patients hospitalized for CA-LRTI was performed during 2010–2013. Based on the findings of chest X-ray and sputum samples, patients were divided into 4 categories, group of bacterial pneumonia or bronchitis, and non-bacterial (viral or etiology-unknown) pneumonia or bronchitis. Peripheral white blood cell and neutrophil counts, and serum C-reactive protein (CRP) and procalcitonin (PCT) levels were compared among the 4 groups. Finally, 54 patients were the subject of this study. In the patients with pneumonia, serum CRP and PCT levels were significantly elevated in the group of bacterial pneumonia (CRP: p = 0.02, PCT: p = 0.0008). The area under the receiver operating characteristic curve for PCT for distinguishing between bacterial and non-bacterial pneumonia was the largest, and sensitivity, specificity, positive predictive value and negative predictive value of PCT were best among 4 markers. On the other hand, in the patients with bronchitis, neutrophil count was significantly decreased in non-bacterial bronchitis whereas no significant differences of WBC count, CRP level or PCT level were seen. In conclusion, PCT was the most useful marker to differentiate bacterial pneumonia whereas neutrophil count contributed most to the discrimination of bacterial bronchitis. The diagnostic performance of biomarkers may be different between pneumonia and bronchitis.
Fatal broncho-pneumonia of an infant with arthrogryposis multiplex congenita (AMC)
2014, Legal Medicine
Citation Excerpt :
It is unreasonable to classify the presented case as a high risk patient for respiratory diseases, as RS virus infection was the only remarkable past history until a few days prior to death. RS virus has been reported as a quite common cause of infection among Japanese children in recent years [23,24] and it is unlikely that it has a high relevance to the fatal pneumonia which occurred a few months after the complete recovery. The mixed inflammatory cell infiltrate with numerous lymphocytes in the wall of bronchiole indicates the presence of an antecedent viral infection prior to the bacterial infection.
Arthrogryposis multiplex congenita (AMC) is a heterogenous group of disorders characterized by multiple joint contractures with an estimated frequency of 1 in 3000–5100 livebirths. The authors present a case of an 11-month-old infant with AMC who died due to severe pneumonia. The deceased had no significant anomaly except for the stated orthpaediatric deformities, and the long-term outcome was expected to be positive. The only remarkable past medical history was respiratory syncytial virus (RS) infection at 6-months old which had taken a few days for a complete recovery. Onset of high fever was observed 3 days prior to her death and she was found in a state of cardiopulmonary arrest in bed by her father in an early morning. Forensic autopsy confirmed the pathohistological diagnosis of severe broncho-pneumonia. The presence of scoliosis and funnel chest was considered to be attributable to the disability to turn herself over and excrete sputum sufficiently, leading to a fatal respiratory complication. This paper stresses the possibility of distal arthrogryposis type of AMC becoming contributory to death despite the initial optimistic prognosis, as well as the importance of postmortem investigation in unexpected fatal cases.
Comparison of a new transport medium with universal transport medium at a tropical field site
2014, Diagnostic Microbiology and Infectious Disease
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Throughout the world, the etiologies of ARIs and pneumonia are largely unknown. It is estimated that 18%–65% of global pediatric patients admitted to the hospital for ARIs and pneumonia are infected with viruses (Arnold et al., 2008; Bonzel et al., 2008; Juven et al., 2000; Tajima et al., 2006; Tsolia et al., 2004), including influenza. Some data from the tropics and subtropics demonstrate incidence and hospitalization rates for influenza that exceed those reported for temperate regions (Brooks and Steinhoff, 2011; Chiu et al., 2002; Henkle et al., 2011; Nascimento-Carvalho et al., 2008; Zaman et al., 2008).
Limited data are available in rural Honduran settings describing the etiology of respiratory infections, partially due to limited specimen transport. A new molecular transport media (MTM) preserves released nucleic acid at ambient temperature for later detection. Prospective surveillance was conducted in a Honduran clinic to identify 233 children less than 5 years of age presenting with respiratory symptoms. We obtained 2 nasopharyngeal samples and stored 1 in PrimeStore® MTM at room temperature and 1 in universal transport media (UTM) at −80 °C. The specimens were then transported to Cincinnati Children's Hospital and tested for 16 respiratory viruses using a multiplex PCR panel. The 2 specimen collection systems were similar for detecting the 4 most common viruses: influenza (Kappa = 0.7676, P < 0.0001), human metapneumovirus (Kappa = 0.8770, P < 0.0001), respiratory syncytial virus (Kappa = 0.6849, P < 0.0001), and parainfluenza (Kappa = 0.8796, P < 0.0001). These results suggest that clinical specimens transported via PrimeStore® MTM and UTM yield similar viral multiplex PCR results.
Haemophilus influenzae type b pneumonia in Egyptian children under five years: A step toward the identification of the real burden in our community by the use of real-time polymerase chain reaction
2012, Egyptian Journal of Medical Human Genetics
Citation Excerpt :
Many studies concluded that Polymerase chain reaction is a rapid and sensitive method for the detection of H. influenzae type b, which has gained greater importance in the last few years because it increased the detection rate by 94% [26–29]. Tajima and coworkers [30] recommended PCR as a robust method for Hib investigation because it can detect and quantify very small amounts of specific nucleic acid sequences. Though bacterial culture did not add to the diagnostic aspect of this study, yet it enabled us to identify antibiotic sensitivity and resistance of the isolated Hib colonies.
Haemophilus influenzae (Hi) causes more than 3 million cases of serious disease, mainly meningitis and pneumonia in children less than 5 years old with approximately 386,000 deaths each year worldwide. The presence or absence of a polysaccharide capsule is an important distinguishing characteristic of H. influenzae species. The polysaccharide capsule can be serologically classified into six serotypes (a to f). Invasive Hi diseases in children were almost exclusively caused by serotype b (Hib). To the best of our knowledge, the real burden of Hib pneumonia in Egypt is not clarified. Yet, few studies are published and concerned with Hib sepsis among neonates or Hib meningitis in children. We aimed in this study to identify the frequency of Hib pneumonia among Egyptian children below five years by the use of real-time polymerase chain reaction (PCR) technique, with insight on antimicrobial resistance of Hib strains in the Egyptian community. One hundred patients with community-acquired pneumonia were investigated for Hib by both real-time PCR and bacterial culture. Haemophilus influenzae type b was diagnosed in 31% of the examined population by PCR, with sensitivity of 100% (95% CI: 0.86–1), specificity 100% (65% CI: 0.93–1), positive predictive value (PPV) 100% (95% CI: 0.83–1), and negative predictive value (NPV) 100% (95% CI: 0.93–1). Blood culture was positive in 12 patients only, with a sensitivity of 38% (95% CI: 0.22–0.57), a specificity of 100% (65% CI: 0.93–1), PPV 100% (95% CI: 0.69–1), and NPV 77% (95% CI: 0.68–0.86). Isolated Hib strains were sensitive to ceftriaxon in 91% of cases, followed by ampicillins in 31% and cotrimoxazole in 17%. Three patients had multidrug resistant strains of Hib.
Haemophilus influenzae type b infection is still an important and frequent pathogen causing community-acquired pneumonia in Egypt with changeable antibiotic sensitivity pattern. PCR represented a sensitive and rapid tool for the diagnosis of Hib pneumonia. Governmental plans to eradicate Hib in our community with the introduction of Hib conjugate vaccine in the national immunization program became indispensable.
Pneumonia in the developed world
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In this paper, we review the literature on the management of pneumonia in the developed world setting. Pneumonia is usually diagnosed on the basis of a cough, respiratory distress, a fever, and chest X-ray changes. Pneumonia affects all paediatric age groups, though the highest incidence is in the under 5 s. There is a significant burden of primary and secondary care illness, although mortality is low. Inpatient admission rates for pneumonia may have increased in recent years in some regions. Pneumonia is unlikely if a child presents with solely wheeze. In routine clinical practice, a microbiological diagnosis is often not made, because current tests are insensitive. Aetiology varies with geographical location, but approximately half of cases are viral. The mainstay of management of moderate pneumonia (the commonest group presenting to secondary care) is careful assessment, and oral antibiotics, followed by early discharge when the patient shows signs of improvement. We summarise the available clinical trial data from the developed world; most of these trials are not adequately powered. Patients with moderately severe pneumonia do not require invasive investigation, but clinical judgement should be used to identify and investigate more complex cases. We discuss several pathogens that have gained importance as causal agents, including non-vaccinated strains of S. pneumoniae, Panton Valentine leucocidin S. aureus, H1N1 Influenza A and Human Bocavirus. The importance of antimicrobial resistance is considered, and we review recent data on long term effects of pneumonia in childhood. By reviewing the available literature, we demonstrate that there are clear evidence gaps, and we suggest future areas for clinical research.

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Etiology and clinical study of community-acquired pneumonia in 157 hospitalized children

Abstract

Pathogens associated with acute lower respiratory tract infection in young children

Pediatr Infect Dis

The causes of hospital-treated acute lower respiratory tract infection in children

Am J Dis Child

Etiology and response to antibiotic therapy of community-acquired pneumonia in French children

Eur J Clin Microbiol Infect Dis

Etiology of community-acquired pneumonia in 254 hospitalized children

Pediatr Infect Dis J

C-reactive protein in viral and bacterial respiratory infection in children

Scand J Infect Dis

Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children

Pediatrics