We report an investigation for 16 bacteria and viruses among 184 children hospitalized with pneumonia in Salvador, Brazil. Etiology was established in 144 (78%) cases. Viral, bacterial, and mixed infections were found in 110 (60%), 77 (42%), and 52 (28%) patients, respectively. Rhinovirus (21%) and Streptococcus pneumoniae (21%) were the most common pathogens. Our results demonstrate the importance of viral and pneumococcal infections among those patients.

Data on the prevalence of pneumooccal nasopharyngeal carriage and its risk factors among adolescents are scarce. The aim of this study was to provide such information. A cross-sectional, population-based prospective study was conducted. Participants were 1013 adolescents (age range 10-19 years) randomly recruited in 22 public schools. Those schools were randomly chosen among 307 public schools from 11 Sanitary Districts of Salvador, Brazil. Nasopharyngeal samples were assessed by standard procedures to recover and identify Streptococcus pneumoniae. Data on potential risk factors were gathered by confidential interview based on a standardized questionnaire. Pneumococci were recovered from 8.2 % [83/1013, 95 % confidence interval (CI) 6.6-10.0]. By stepwise logistic regression, pneumococcal colonization was independently associated with younger age [odds ratio (OR) 0.85, 95 % CI 0.77-0.94, P50.001], being male (OR 1.78, 95 % CI 1.11-2.85, P50.02), exposure to passive smoke in the household (OR 1.76, 95 % CI 1.10-2.79, P50.02), having an upper respiratory infection during recruitment (OR 2.67, 95 % CI 1.67-4.28, P,0.001) and having a history involving an episode of acute asthma during the last year (OR 2.89, 95 % CI 1.18-7.08, P50.03). The estimated probability of pneumococcal colonization decreased with age (x 2 for trend58.52, P50.003). These findings provide tools for increasing the use of prevention strategies for pneumococcal diseases, such as pneumococcal vaccination among asthmatic patients and public health measures to stop smoking. INTRODUCTIONThe incidence of invasive pneumococcal disease is highest among children and the elderly (CDC, 1997). However, respiratory infections are an important cause of morbidity and mortality among adolescents (Benguigui, 1992). Among children, Streptococcus pneumoniae is a major causative agent of such infections (Heiskanen-Kosma et al., 1998). The nasopharynx is known to be the main ecological reservoir of S. pneumoniae, from where it can give rise to disease after extending to other areas of the respiratory tract or penetrating normally sterile body fluids (Austrian, 1986). Although nasopharyngeal isolates are not useful for predicting the causative agent of invasive disease in individuals, they reflect epidemiological aspects of pneumococcal disease in the community (Brueggemann et al., 2003).Studies conducted over the last decades have gradually revealed the connection between pneumococcal carriage, and mucosal and invasive infections caused by the (Inostroza et al., 1998). Thus, we estimated that 900 participants would be sufficient to detect a prevalence and the respective 95 % confidence interval (CI) of nasopharyngeal colonization ranging from 8-12 % (point prevalence510 %, 2 % error). We assumed a 12 % refusal to participate, so the sample size was established as 1000 participants. Demographic, clinical and epidemiological data were collected by a standardized questionnaire.Bacteriological data. Two trained biochemists collected nasopharyngeal specimens by rotat...

Data to inform policy decisions would be improved by information on burden and etiology of severe pneumonia, population-based incidence of ambulatory visits and hospitalizations and prevalence of complications and sequelae.

Objective: To assess the gross motor development of children with presumed congenital Zika virus (ZIKV) infection over the first 2 years of their lives. Methods: Seventy-seven children were assessed at the median ages of 11, 18, and 24 months, using the evaluative instrument Gross Motor Function Measure (GMFM-66). At the third assessment, the children with diagnoses of cerebral palsy (CP) were classified by severity through the Gross Motor Function Classification System (GMFCS) and stratified by topography indicating the predominantly affected limbs. With these instruments in combination and using the motor development curves as reference, the rate of development and functional ability were estimated. Results: At 2 years of age, all children had the diagnosis of CP. Seventy-four (96.1%) presented gross motor skills similar to those of children aged 4 months or younger, according to the World Health Organization's standard. The GMFM-66 median score among the 73 (94.8%) children with quadriplegia and GMFCS level V showed significant change between 11 and 18 months (p < 0.001) and between 11 and 24 months (p < 0.001). No significant difference (p = 0.076) was found between 18 and 24 months. Conclusion: Despite showing some gross motor progress during the initial 18 months of life, these children with presumed congenital ZIKV infection and CP experienced severe motor impairment by 2 years of age. According to the motor development curves, these children with quadriplegia have probably already reached about 90% of their motor development potential.

Intravenous penicillin/ampicillin remains the drug of choice for treating penicillin-resistant pneumococcal pneumonia in areas where the MIC does not exceed 2 microg/ml.

Human bocavirus (HBoV) is a human virus associated with respiratory disease in children. Limited information is available on acute infection with HBoV among children admitted to hospital with community-acquired pneumonia in tropical regions and the current diagnosis is inadequate. The aims were to diagnose and describe acute HBoV infections among children hospitalized for community-acquired pneumonia. In Salvador, Brazil, 277 children with community-acquired pneumonia were prospectively enrolled. Paired serum samples were tested by IgG, IgM, and IgG-avidity enzyme immunoassays (EIAs) using recombinant HBoV VP2. HBoV DNA was detected in nasopharyngeal aspirates and serum by a quantitative polymerase-chain reaction (PCR). HBoV DNA was detected in nasopharyngeal aspirates of 62/268 (23%) children and 156/273 (57%) were seropositive. Acute primary HBoV infection was reliably diagnosed (bearing at least two acute markers: Positive IgM, a fourfold increase/conversion of IgG, low IgG avidity or viremia) in 21 (8%) of 273 patients, 90% of 20 had HBoV DNA in nasopharyngeal aspirates, 83% with a high DNA load. The median age of infection with HBoV was 16 months, range 5-36. Community-acquired pneumonia was confirmed radiographically in 85% of 20 patients with acute HBoV infection diagnosed serologically. HBoV DNA was found in nasopharyngeal aspirates of 42/246(17%) children without an acute primary HBoV infection and available nasopharyngeal aspirate. Four children with HBoV secondary immune responses were detected, lacking both IgM and viremia. HBoV infection was diagnosed accurately in children aged 5-36 months with community-acquired pneumonia confirmed radiographically. PCR of nasopharyngeal aspirates is not a reliable marker of acute HBoV infection.

Objective To examine the ability of the criteria proposed by the WHO to identify pneumonia among cases presenting with wheezing and the extent to which adding fever to the criteria alters their performance. Design Prospective classifi cation of 390 children aged 2-59 months with lower respiratory tract disease into fi ve diagnostic categories, including pneumonia. WHO criteria for the identifi cation of pneumonia and a set of such criteria modifi ed by adding fever were compared with radiographically diagnosed pneumonia as the gold standard. Results The sensitivity of the WHO criteria was 94% for children aged <24 months and 62% for those aged ≥24 months. The corresponding specifi cities were 20% and 16%. Adding fever to the WHO criteria improved specifi city substantially ( to 44% and 50%, respectively). The specifi city of the WHO criteria was poor for children with wheezing (12%). Adding fever improved this substantially ( to 42%). The addition of fever to the criteria apparently reduced their sensitivity only marginally (to 92% and 57%, respectively, in the two age groups). Conclusion The authors' results reaffi rm that the current WHO criteria can detect pneumonia with high sensitivity, particularly among younger children. They present evidence that the ability of these criteria to distinguish between children with pneumonia and those with wheezing diseases might be greatly enhanced by the addition of fever.Pneumonia is still a leading disease in childhood in developing countries. 1 2 The WHO has developed guidelines, based on simple clinical signs, for the identifi cation and treatment of pneumonia in developing countries. 3 4 Despite widespread recognition that the WHO case management strategy has helped to reduce mortality, 5 there is concern that children with non-severe pneumonia are still receiving antibiotics unnecessarily. Studies have reported a lot of antibiotic treatment failure for pneumonia in children with wheeze, 6 7 suggesting they constitute a special group requiring a separate management algorithm. 7 8 We examined the ability of the WHO criteria to identify pneumonia among cases presenting with wheezing and how adding fever to these criteria altered their performance. PATIENTS AND METHODSWe analysed data from a prospective study on children living in São Paulo, Brazil. Details of the clinical data have already been published. 9 Study population and diagnostic defi nitionsChildren aged between 2 and 59 months presenting to the paediatric emergency departments of fi ve public hospitals in a 15-month period were screened by a paediatrician upon arrival. Children with acute lower respiratory tract disease (LRTD) (wheezing, rales, tachypnoea, and/or dyspnoea were considered to be signs of LRTD) whose parents gave informed consent, were recruited into the study, excluding those with: recent history of aspiration (liquid or foreign body); tuberculosis; measles; pertussis; congenital, inherited, neurological, neuromuscular or immunological diseases; cancer; or gastrooesophageal refl ux...

Pneumonia is an important cause of morbidity and mortality among children throughout the world. Vaccines are available for some organisms, but they are underutilized and/or still in development. To evaluate the potential impact of vaccines, we review studies in which the etiology of childhood community-acquired pneumonia was recorded. In North America and Europe (9 studies), the etiology of pneumonia was established in 62% of studied children (range 43%-88%) by use of noninvasive specific methods for microbiologic diagnosis. The most often identified agents were S. pneumoniae (22%), respiratory syncytial virus (RSV) (20%), Haemophilus influenzae (7%), and Mycoplasma pneumoniae (15%). In Africa and South America (8 studies), bacteria were recovered from 56% (range 32%-68%) of severely ill children studied by lung aspirate. The most often isolated bacteria were Streptococcus pneumoniae (33%) and Haemophilus influenzae (21%). A high percentage of H. influenzae strains were not serotype b. Throughout the world, children requiring hospitalization were most likely to have infection caused by pneumococcus H. influenzae or RSV. Out patients also had Mycoplasma pneumoniae. Countries in Africa and Asia recorded 2 to 10 times more children with pneumonia (7 to 40/100 annually) than in the USA. Widespread use of pneumococcal and H. influenzae type b conjugate vaccines could reduce the frequency of childhood pneumonia by one-third. Further reduction will require development of non-type b H. influenzae, RSV and M. pneumoniae vaccines. This could result in a > 50% reduction of pneumonia in children. This goal should be sought and achieved as soon as possible.