Infection by Streptococcus pneumoniae in children with or without radiologically confirmed pneumonia

Andrade, Dafne C.; Borges, Igor C.; Vilas-Boas, Ana Luisa; Fontoura, M.-S. H.; Araújo-Neto, César A.; Andrade, Sandra C.; Brim, Rosa; Meinke, Andreas; Barral, Aldina; Ruuskanen, Olli; Käyhty, Helena; Nascimento‐Carvalho, Cristiana M.

doi:10.1016/j.jped.2017.03.004

Cited by 12 publications

(7 citation statements)

References 26 publications

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“…31 Esses achados foram detectados em crianças hospitalizadas 31 e não hospitalizadas. 32 Isso significa que os achados de pneumonia confirmada radiologicamente são, na verdade, preditores de pneumonia bacteriana. Além disso, se a frequência de pneumonia bacteriana está diminuindo devido à ampla implantação das vacinas conjugadas (Hib e PCV), a precisão desses preditores pode mudar ao longo do tempo e entre um e outro ambiente, depende da cobertura das vacinas.…”

Section: Diagnósticounclassified

Community-acquired pneumonia among children: the latest evidence for an updated management

Nascimento‐Carvalho¹

2020

Jornal de Pediatria

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Objective: To provide cutting-edge information for the management of community-acquired pneumonia in children under 5 years, based on the latest evidence published in the literature. Data source: A comprehensive search was conducted in PubMed, by using the expressionsAll articles retrieved had the title and the abstract read, when the papers reporting the latest evidence on each subject were identified and downloaded for complete reading. Data synthesis: In the era of largely implemented bacterial conjugate vaccines and widespread use of amplification nucleic acid techniques, respiratory viruses have been identified as the most frequent causative agents of community-acquired pneumonia in patients under 5 years. Hypoxemia (oxygen saturation ≤96%) and increased work of breathing are signs most associated with community-acquired pneumonia. Wheezing detected on physical examination independently predicts viral infection and the negative predictive value (95% confidence interval) of normal chest X-ray and serum procalcitonin <0.25 ng/dL was 92% (77---98%) and 93% (90---99%), respectively. Inability to drink/feed, vomiting everything, convulsions, lower chest indrawing, central cyanosis, lethargy, nasal flaring, grunting, head nodding, and oxygen saturation <90% are predictors of death and can be used as indicators for hospitalization. Moderate/large pleural effusions and multilobar infiltrates are predictors of severe disease. Orally administered amoxicillin is the first line outpatient treatment, while ampicillin, aqueous penicillin G, or amoxicillin (initiated initially by intravenous route) are the first line options to treat inpatients. Conclusions: Distinct aspects of childhood community-acquired pneumonia have changed during the last three decades.

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Section: Diagnósticounclassified

Community-acquired pneumonia among children: the latest evidence for an updated management

Nascimento‐Carvalho¹

2020

Jornal de Pediatria

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“…Nasopharyngeal (NP) colonization by antimicrobial-resistant Streptococcus pneumoniae (pneumococcus) is a global public health concern (Ginsburg and Klugman, 2017). The pneumococcus is an important bacterial cause of childhood pneumonia (O’Brien et al, 2009; Andrade et al, 2018). NP colonization with pneumococci is a prerequisite for development of pneumococcal disease (Bogaert et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

Nasopharyngeal Carriage of Antimicrobial-Resistant Pneumococci in an Intensively Sampled South African Birth Cohort

et al. 2019

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Introduction: Nasopharyngeal (NP) colonization by Streptococcus pneumoniae (pneumococcus) precedes the development of respiratory tract infection. Colonization by antimicrobial-resistant pneumococci, especially in infants, is a major public health concern. We longitudinally investigated antimicrobial-resistance amongst pneumococci colonizing the nasopharynx of South African infants immunized with the 13-valent pneumococcal conjugate vaccine (PCV13). Methods: NP swabs were collected every second week from birth through the first year of life from 137 infants. Pneumococci were identified and serotyped using conventional microbiological techniques, and their antibiotic susceptibility profiles determined by disk diffusion and E -test. Results: All infants were immunized with 3 doses of PCV13. 1520 pneumococci (760 non-repeat) isolates were recovered from 137 infants; including non-typeable ( n = 99), PCV13 ( n = 133) and non-PCV13 serotypes ( n = 528). The prevalence of penicillin, erythromycin, and cotrimoxazole non-susceptibility was 19% (95% CI 17–22%) (3% fully resistant), 18% (95% CI 15–21%) (14% fully resistant), and 45% (95% CI 42–49%) (36% fully resistant), respectively. The predominant penicillin-non-susceptible serotypes included 19A, 19F, 15B/15C, 15A, and 21, while susceptible serotypes included 23A, 34, and 17A. Multidrug-resistance (MDR) was observed in 9% (95% CI 7–11%) of the isolates. PCV13 serotypes were more likely to be non-susceptible, compared to non-PCV13 serotypes, to penicillin (26% vs. 16%, p = 0.007), erythromycin (23% vs. 15%, p = 0.027) and cotrimoxazole (62% vs. 41%, p < 0.001). Non-susceptibility to penicillin, erythromycin, and cotrimoxazole remained relatively constant through the first year of life ( X 2 test for trend: p = 0.184, p = 0.171, and p = 0.572, respectively). Overall, penicillin or erythromycin-non-susceptible pneumococci were carried for a shorter duration than susceptible pneumococci [penicillin (mean days, 18 vs. 21, p = 0.013) and erythromycin (mean days, 18 vs. 21, p = 0.035)]. Within individual infants carrying the same serotype longitudinally, changes in antibiotic susceptibility were observed over time in 45% (61/137) of infants and these changes were predominantly for penicillin (76%, 79/104). Conclusion: Prevalence of NP carriage with antibiotic-non-susceptible pneumococci was relatively constant throughout the first year of life. PCV13 serotypes were more commonly non-susceptible to penicillin, erythromycin, and cotrimoxazole. Penicillin or erythromycin-non-susceptible pneumococci were carried for a shorter duration than penicillin or erythrom...

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“… 44 Moreover, our panel did not include S. pneumoniae paired serology, which may be useful to increase pneumococcal diagnosis in young children. 45 Nonetheless, S. pneumoniae remains an important aetiological agent of severe/complicated CAP globally. 46 Our finding that S. pneumoniae was significantly associated with severe cases by the WHO classification system supports the need for ongoing surveillance, vaccination and prevention of transmission between adults and children.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of community-acquired pneumonia among hospitalised children in Indonesia: a multicentre, prospective study

et al. 2022

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ObjectiveTo identify aetiologies of childhood community-acquired pneumonia (CAP) based on a comprehensive diagnostic approach.Design‘Partnerships for Enhanced Engagement in Research-Pneumonia in Paediatrics (PEER-PePPeS)’ study was an observational prospective cohort study conducted from July 2017 to September 2019.SettingGovernment referral teaching hospitals and satellite sites in three cities in Indonesia: Semarang, Yogyakarta and Tangerang.ParticipantsHospitalised children aged 2–59 months who met the criteria for pneumonia were eligible. Children were excluded if they had been hospitalised for >24 hours; had malignancy or history of malignancy; a history of long-term (>2 months) steroid therapy, or conditions that might interfere with compliance with study procedures.Main outcome(s) measure(s)Causative bacterial, viral or mixed pathogen(s) for pneumonia were determined using microbiological, molecular and serological tests from routinely collected specimens (blood, sputum and nasopharyngeal swabs). We applied a previously published algorithm (PEER-PePPeS rules) to determine the causative pathogen(s).Results188 subjects were enrolled. Based on our algorithm, 48 (25.5%) had a bacterial infection, 31 (16.5%) had a viral infection, 76 (40.4%) had mixed bacterial and viral infections, and 33 (17.6%) were unable to be classified. The five most common causative pathogens identified were Haemophilus influenzae non-type B (N=73, 38.8%), respiratory syncytial virus (RSV) (N=51, 27.1%), Klebsiella pneumoniae (N=43, 22.9%), Streptococcus pneumoniae (N=29, 15.4%) and Influenza virus (N=25, 13.3%). RSV and influenza virus diagnoses were highly associated with Indonesia’s rainy season (November–March). The PCR assays on induced sputum (IS) specimens captured most of the pathogens identified in this study.ConclusionsOur study found that H. influenzae non-type B and RSV were the most frequently identified pathogens causing hospitalised CAP among Indonesian children aged 2–59 months old. Our study also highlights the importance of PCR for diagnosis and by extension, appropriate use of antimicrobials.Trail registration numberNCT03366454

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Infection by Streptococcus pneumoniae in children with or without radiologically confirmed pneumonia

Abstract: Among children with clinical diagnosis of community-acquired pneumonia submitted to chest radiograph, those with radiologically confirmed pneumonia present a higher rate of infection by S. pneumoniae when compared with those with a normal chest radiograph.

Cited by 12 publications

References 26 publications

Community-acquired pneumonia among children: the latest evidence for an updated management

Community-acquired pneumonia among children: the latest evidence for an updated management

Nasopharyngeal Carriage of Antimicrobial-Resistant Pneumococci in an Intensively Sampled South African Birth Cohort

Epidemiology of community-acquired pneumonia among hospitalised children in Indonesia: a multicentre, prospective study

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