Etiology and the challenge of diagnostic testing of community-acquired pneumonia in children and adolescents

BMC Pediatrics

Mónica Trujillo¹  Claudia Roya-Pabón²  Carlos Garcés²  Olga Morales²  Catalina Arango²  Andrea Restrepo³  Mariana Herrera⁴  Zulma Vanessa Rueda⁴  Lucelly López⁵  Cristian Vera⁵  Yudy Aguilar⁶  Lázaro A. Vélez⁶  Ángela Rocio Copete⁶  Margarita Rosa Giraldo⁷  María Angélica Maya⁸ 

[1] Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana;Departamento de Pediatría y Puericultura, Grupo Pediaciencias, Universidad de Antioquia UdeA;Departamento de Pediatría, Hospital Pablo Tobón Uribe;Department of Medical Microbiology and Infectious Diseases, University of Manitoba;Facultad de Medicina, Universidad Pontificia Bolivariana;Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), Facultad de Medicina, Universidad de Antioquia UdeA;Secretaría Seccional de Salud y Protección Social de Antioquia, Gobernación de Antioquia;Unidad de Enfermedades Infecciosas, Hospital Universitario San Vicente Fundación;

关键词: Pneumonia;    Diagnosis;    Etiology;    Multiplex PCR;    Serology;    Induced sputum;   

DOI  :  10.1186/s12887-022-03235-z

来源: DOAJ

【 摘 要 】

Abstract Background Pneumonia is the leading cause of mortality in pediatric population. The etiology of pneumonia in this population is variable and changes according to age and disease severity and where the study is conducted. Our aim was to determine the etiology of community-acquired pneumonia (CAP) in children aged 1 month to 17 years admitted to 13 Colombian hospitals. Methods Prospective cohort study. Hospitalized children with radiologically confirmed CAP and ≤ 15 days of symptoms were included and followed together with a control group. Induced sputum (IS) was submitted for stains and cultures for pyogenic bacteria and Mycobacterium tuberculosis, and multiplex PCR (mPCR) for bacteria and viruses; urinary antigens for pneumococcus and Legionella pneumophila; nasopharyngeal swabs for viruses, and paired serology for atypical bacteria and viruses. Additional cultures were taken at the discretion of primary care pediatricians. Results Among 525 children with CAP, 71.6% had non-severe pneumonia; 24.8% severe and 3.6% very severe pneumonia, and no fatal cases. At least one microorganism was identified in 84% of children and 61% were of mixed etiology; 72% had at least one respiratory virus, 28% pyogenic bacteria and 21% atypical bacteria. Respiratory syncytial virus, Parainfluenza, Rhinovirus, Influenza, Mycoplasma pneumoniae, Adenovirus and Streptococcus pneumoniae were the most common etiologies of CAP. Respiratory syncytial virus was more frequent in children under 2 years and in severe pneumonia. Tuberculosis was diagnosed in 2.3% of children. IS was the most useful specimen to identify the etiology (33.6%), and blood cultures were positive in 3.6%. The concordance between all available diagnostic tests was low. A high percentage of healthy children were colonized by S. pneumoniae and Haemophilus influenzae, or were infected by Parainfluenza, Rhinovirus, Influenza and Adenovirus. Conclusions Respiratory viruses are the most frequent etiology of CAP in children and adolescents, in particular in those under 5 years. This study shows the challenges in making an etiologic diagnosis of CAP in pediatric population because of the poor concordance between tests and the high percentage of multiple microorganisms in healthy children. IS is useful for CAP diagnosis in pediatric population.

【 授权许可】

Unknown