Top

Published in:

01-12-2009 | Original Paper

Etiology of community-acquired pneumonia in hospitalized children based on WHO clinical guidelines

Authors: Manon Cevey-Macherel, Annick Galetto-Lacour, Alain Gervaix, Claire-Anne Siegrist, Jacques Bille, Béatrice Bescher-Ninet, Laurent Kaiser, Jean-Daniel Krahenbuhl, Mario Gehri

Published in: European Journal of Pediatrics | Issue 12/2009

Abstract

Community-acquired pneumonia (CAP) is a major cause of death in developing countries and of morbidity in developed countries. The objective of the study was to define the causative agents among children hospitalized for CAP defined by WHO guidelines and to correlate etiology with clinical severity and surrogate markers. Investigations included an extensive etiological workup. A potential causative agent was detected in 86% of the 99 enrolled patients, with evidence of bacterial (53%), viral (67%), and mixed (33%) infections. Streptococcus pneumoniae was accounted for in 46% of CAP. Dehydration was the only clinical sign associated with bacterial pneumonia. CRP and PCT were significantly higher in bacterial infections. Increasing the number of diagnostic tests identifies potential causes of CAP in up to 86% of children, indicating a high prevalence of viruses and frequent co-infections. The high proportion of pneumococcal infections re-emphasizes the importance of pneumococcal immunization.

Ayieko P, English M (2007) Case management of childhood pneumonia in developing countries. Pediatr Infect Dis J 26(5):432–440, doi:10.1097/01.inf.0000260107.79355.7d CrossRefPubMed

British Thoracic Society (2002) Guidelines for the management of community acquired pneumonia in childhood. Thorax 57(Suppl 1):1–24, doi:10.1136/thorax.57.1.1

Calvo C, Garcia-Garcia ML, Blanco C, Pozo F, Casas Flecha I, Perez-Brena P (2007) Role of rhinovirus in hospitalized infants with respiratory tract infection in Spain. Pediatr Infect Dis 26:904–908CrossRef

Carvhalo MA, Tondella ML, Dagan R, Sampson JS (2007) Evaluation and improvement of real-time PCR assays targeting lytA, and psaA genes for detection of pneumococcal DNA. J Clin Microbiol 45(8):2460–2466, doi:10.1128/JCM.02498-06 CrossRef

Cherian T, Mulholland EK, Carlin JB, Ostensen H, Amin R (2005) Standardized interpretation of paediatric chest radiographs for the diagnosis of pneumonia in epidemiological studies. Bull World Health Organ 83(5):353–359PubMed

Claesson BA, Trollfors B, Brolin I, Granstrom M, Henrichsen J, Jodal U (1989) Etiology of community-acquired pneumonia in children based on antibody responses to bacterial and viral antigens. Pediatr Infect Dis J 8(12):856–862, doi:10.1097/00006454-198912000-00006 PubMed

Coote N, McKenzie S (2000) Diagnosis and investigation of bacterial pneumonias. Paediatr Respir Rev 1(1):8–13, doi:10.1053/prrv.2000.0002 CrossRefPubMed

Corless CE, Guiver M, Borrow R, Edwards-Jones V, Fox AJ, Kaczmarski EB (2001) Simultaneous detection of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae in suspected cases of meningitis and septicemia using real-time PCR. J Clin Microbiol 39(4):1553–1558, doi:10.1128/JCM.39.4.1553-1558.2001 CrossRefPubMed

Cunha BA (2004) Therapeutic implications of antibacterial resistance in community-acquired respiratory tract infections in children. Infection 32(2):98–108, doi:10.1007/s15010-004-3065-5 CrossRefPubMed

10.

Cutts FT, Zaman SM, Enwere G, Jaffar S, Levine OS, Okoko JB (2005) Efficacy of nine-valent pneumococcal conjugate vaccine against pneumonia and invasive pneumococcal disease in The Gambia: randomised, double-blind, placebo-controlled trial. Lancet 365(9465):1139–1146CrossRefPubMed

11.

Dirlewanger M, Krahenbuhl JD, Fanconi S, Vaudaux B, Gehri M (2002) Community-acquired pneumonia in children aged 2 months to 5 years: application of the WHO guidelines in a developed country setting (Switzerland). Eur J Pediatr 161(8):460–461, doi:10.1007/s00431-002-0993-x CrossRefPubMed

12.

Don M, Fasoli L, Paldanius M, Vainionpaa R, Kleemola M, Raty R (2005) Aetiology of community-acquired pneumonia: serological results of a paediatric survey. Scand J Infect Dis 37(11–12):806–812, doi:10.1080/00365540500262435 CrossRefPubMed

13.

Don M, Valent F, Korppi M, Falleti E, De CA, Fasoli L (2007) Efficacy of serum procalcitonin in evaluating severity of community-acquired pneumonia in childhood. Scand J Infect Dis 39(2):129–137, doi:10.1080/00365540600951283 CrossRefPubMed

14.

Drummond P, Clark J, Wheeler J, Galloway A, Freeman R, Cant A (2000) Community acquired pneumonia: a prospective UK study. Arch Dis Child 83(5):408–412, doi:10.1136/adc.83.5.408 CrossRefPubMed

15.

Garbino J, Crespo S, Aubert JD, Rochat T, Ninet B, Deffernez C (2006) A prospective hospital-based study of the clinical impact of non-severe acute respiratory syndrome (non-SARS)-related human coronavirus infection. Clin Infect Dis 43(8):1009–1015, doi:10.1086/507898 CrossRefPubMed

16.

Garbino J, Gerbase MW, Wunderli W, Deffernez C, Thomas Y, Rochat T (2004) Lower respiratory viral illnesses: improved diagnosis by molecular methods and clinical impact. Am J Respir Crit Care Med 170(11):1197–1203, doi:10.1164/rccm.200406-781OC CrossRefPubMed

17.

Gove S (1997) Integrated management of childhood illness by outpatient health workers: technical basis and overview. The WHO working group on guidelines for integrated management of the sick child. Bull World Health Organ 75(Suppl 1):7–24PubMed

18.

Hansen J, Black S, Shinefield H, Cherian T, Benson J, Fireman B (2006) Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than 5 years of age for prevention of pneumonia: updated analysis using World Health Organization standardized interpretation of chest radiographs. Pediatr Infect Dis J 25(9):779–781, doi:10.1097/01.inf.0000232706.35674.2f CrossRefPubMed

19.

Heath PT (2000) Epidemiology and bacteriology of bacterial pneumonias. Paediatr Respir Rev 1(1):4–7, doi:10.1053/prrv.2000.0001 CrossRefPubMed

20.

Hedlund J, Hansson LO (2000) Procalcitonin and C-reactive protein levels in community-acquired pneumonia: correlation with etiology and prognosis. Infection 28(2):68–73, doi:10.1007/s150100050049 CrossRefPubMed

21.

Heiskanen-Kosma T, Korppi M, Jokinen C, Kurki S, Heiskanen L, Juvonen H (1998) Etiology of childhood pneumonia: serologic results of a prospective, population-based study. Pediatr Infect Dis J 17(11):986–991, doi:10.1097/00006454-199811000-00004 CrossRefPubMed

22.

Jalonen E, Paton JC, Koskela M, Kerttula Y, Leinonen M (1989) Measurement of antibody responses to pneumolysin—a promising method for the presumptive aetiological diagnosis of penumococcal pneumonia. J Infect 19(2):127–134, doi:10.1016/S0163-4453(89)91864-1 CrossRefPubMed

23.

Juven T, Mertsola J, Waris M, Leinonen M, Meurman O, Roivainen M (2000) Etiology of community-acquired pneumonia in 254 hospitalized children. Pediatr Infect Dis J 19(4):293–298, doi:10.1097/00006454-200004000-00006 CrossRefPubMed

24.

Juven T, Ruuskanen O, Mertsola J (2003) Symptoms and signs of community-acquired pneumonia in children. Scand J Prim Health Care 21(1):52–56, doi:10.1080/02813430310000573 CrossRefPubMed

25.

Kaiser L, Aubert JD, Pache JC, Deffernez C, Rochat T, Garbino J (2006) Chronic rhinoviral infection in lung transplant recipients. Am J Respir Crit Care Med 174(12):1392–1399CrossRefPubMed

26.

Kanclerski K, Blomquist S, Granstrom M, Mollby R (1988) Serum antibodies to pneumolysin in patients with pneumonia. J Clin Microbiol 26(1):96–100PubMed

27.

Kee C, Palladino S, Kay I, Pryce TM, Murray R, Rello J, Gallego M, Lujan M, Munoz-Almagro C, Waterer GW (2008) Feasibility of real-time polymerase reaction in whole blood to identify Streptococcus pneumoniae in patients with community-acquired pneumonia. Diagn Microbiol Infect Dis 61(1):72–75, doi:10.1016/j.diagmicrobio.2007.12.011 CrossRefPubMed

28.

Korppi M, Heiskanen-Kosma T, Jalonen E, Saikku P, Leinonen M, Halonen P (1993) Aetiology of community-acquired pneumonia in children treated in hospital. Eur J Pediatr 152(1):24–30, doi:10.1007/BF02072512 CrossRefPubMed

29.

Madhi SA, Kohler M, Kuwanda L, Cutland C, Klugman KP (2006) Usefulness of C-reactive protein to define pneumococcal conjugate vaccine efficacy in the prevention of pneumonia. Pediatr Infect Dis J 25(1):30–36, doi:10.1097/01.inf.0000195787.99199.4a CrossRefPubMed

30.

Madhi SA, Levine OS, Hajjeh R, Mansoor OD, Cherian T (2008) Vaccines to prevent pneumonia and improve child survival. Bull World Health Organ 86(5):365–372, doi:10.2471/BLT.07.044503 CrossRefPubMed

31.

McCracken GH (2000) Diagnosis and management of pneumonia in children. Pediatr Infect Dis J 19(9):924–928, doi:10.1097/00006454-200009000-00036 CrossRefPubMed

32.

Michelow IC, Olsen K, Lozano J, Rollins NK, Duffy LB, Ziegler T (2004) Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children. Pediatrics 113(4):701–707, doi:10.1542/peds.113.4.701 CrossRefPubMed

33.

Moulin F, Raymond J, Lorrot M, Marc E, Coste J, Iniguez JL (2001) Procalcitonin in children admitted to hospital with community acquired pneumonia. Arch Dis Child 84(4):332–336, doi:10.1136/adc.84.4.332 CrossRefPubMed

34.

Nakayama E, Hasegawa K, Morozumi M, Kobayashi R, Chiba N, Iitsuka T (2007) Rapid optimization of antimicrobial chemotherapy given to pediatric patients with community-acquired pneumonia using PCR techniques with serology and standard culture. J Infect Chemother 13(5):305–313, doi:10.1007/s10156-007-0535-6 CrossRefPubMed

35.

Nohynek H, Eskola J, Kleemola M, Jalonen E, Saikku P, Leinonen M (1995) Bacterial antibody assays in the diagnosis of acute lower respiratory tract infection in children. Pediatr Infect Dis J 14(6):478–484PubMedCrossRef

36.

Peltola V, Waris M, Osterback R, Susi P, Hyypiä T, Ruuskanen O (2008) Clinical effects of rhinovirus infections. J Clin Virol 43(4):411–414, doi:10.1016/j.jcv.2008.08.014 CrossRefPubMed

37.

Prat C, Dominguez J, Rodrigo C, Gimenez M, Azuara M, Jimenez O (2003) Procalcitonin, C-reactive protein and leukocyte count in children with lower respiratory tract infection. Pediatr Infect Dis J 22(11):963–968, doi:10.1097/01.inf.0000095197.72976.4f CrossRefPubMed

38.

Renwick N, Schweiger B, Kapoor V, Liu Z, Villari J, Bullmann R, Miething R, Briese T, Lipkin WI (2007) A recently identified rhinovirus genotype is associated with severe respiratory-tract infection in children in Germany. J Infect Dis 196(12):1754–1760, doi:10.1086/524312 CrossRefPubMed

39.

Ruuskanen O, Nohynek H, Ziegler T, Capeding R, Rikalainen H, Huovinen P (1992) Pneumonia in childhood: etiology and response to antimicrobial therapy. Eur J Clin Microbiol Infect Dis 11(3):217–223, doi:10.1007/BF02098083 CrossRefPubMed

40.

Sinaniotis CA (2004) Viral pneumoniae in children: incidence and aetiology. Paediatr Respir Rev 5(Suppl A):S197–S200, doi:10.1016/S1526-0542(04)90037-1 CrossRefPubMed

41.

Stein RT, Marostica PJ (2007) Community-acquired pneumonia: a review and recent advances. Pediatr Pulmonol 42(12):1095–1103, doi:10.1002/ppul.20652 CrossRefPubMed

42.

Tsolia MN, Psarras S, Bossios A, Audi H, Paldanius M, Gourgiotis D (2004) Etiology of community-acquired pneumonia in hospitalized school-age children: evidence for high prevalence of viral infections. Clin Infect Dis 39(5):681–686, doi:10.1086/422996 CrossRefPubMed

43.

Van Haeften R, Palladino S, Kay I, Keil T, Heath C, Waterer GW (2003) A quantitative LightCycler PCR to detect Streptococcus pneumoniae in blood and CSF. Diagn Microbiol Infect Dis 47(2):407–414, doi:10.1016/S0732-8893(03)00129-9 CrossRefPubMed

44.

Welti M, Jaton K, Altwegg M, Sahli R, Wenger A, Bille J (2003) Development of a multiplex real-time quantitative PCR assay to detect Chlamydia pneumoniae, Legionella pneumophila and Mycoplasma pneumoniae in respiratory tract secretions. Diagn Microbiol Infect Dis 45(2):85–95, doi:10.1016/S0732-8893(02)00484-4 CrossRefPubMed

45.

Williams BG, Gouws E, Boschi-Pinto C, Bryce J, Dye C (2002) Estimates of world-wide distribution of child deaths from acute respiratory infections. Lancet Infect Dis 2(1):25–32, doi:10.1016/S1473-3099(01)00170-0 CrossRefPubMed

Title: Etiology of community-acquired pneumonia in hospitalized children based on WHO clinical guidelines
Authors: Manon Cevey-Macherel
Annick Galetto-Lacour
Alain Gervaix
Claire-Anne Siegrist
Jacques Bille
Béatrice Bescher-Ninet
Laurent Kaiser
Jean-Daniel Krahenbuhl
Mario Gehri
Publication date: 01-12-2009
Publisher: Springer-Verlag
Published in: European Journal of Pediatrics / Issue 12/2009
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-009-0943-y

At a glance: The STEP trials

Springer Medicine

Etiology of community-acquired pneumonia in hospitalized children based on WHO clinical guidelines

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 12/2009

Effect of caffeine on respiratory muscle strength and lung function in prematurely born, ventilated infants

Bone maturation in extremely low birth weight infants in relation to birth weight and endocrine parameters

Febrile seizures: a cloudy issue

Double aortic arch with double aneuploidy—rare anomaly in combined Down and Klinefelter syndrome

Clinical practice

False-negative results of pre-discharge neonatal bilirubin screening to predict severe hyperbilirubinemia: a need for caution