PERCH in Perspective: What Can It Teach Us About Pneumonia Etiology in Children?

Klugman, Keith P.; Rodgers, Gail L.

doi:10.1093/cid/cix075

Cited by 10 publications

(10 citation statements)

References 13 publications

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“…The lack of robust evidence on pneumonia aetiology in this age group means that best practice with regard to antibiotic treatment really is unknown. The recently completed Pneumonia Aetiology Research for Child Health study sought to refresh understanding of paediatric pneumonia aetiology in LMICs, but focused exclusively on under 5s 43. Unfortunately, we were unable to confirm aetiology in our study due to the limited diagnostic capacity of the study hospitals 8.…”

Section: Discussionmentioning

confidence: 91%

Risk factors for death among children aged 5–14 years hospitalised with pneumonia: a retrospective cohort study in Kenya

et al. 2019

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IntroductionThere were almost 1 million deaths in children aged between 5 and 14 years in 2017, and pneumonia accounted for 11%. However, there are no validated guidelines for pneumonia management in older children and data to support their development are limited. We sought to understand risk factors for mortality among children aged 5–14 years hospitalised with pneumonia in district-level health facilities in Kenya.MethodsWe did a retrospective cohort study using data collected from an established clinical information network of 13 hospitals. We reviewed records for children aged 5–14 years admitted with pneumonia between 1 March 2014 and 28 February 2018. Individual clinical signs were examined for association with inpatient mortality using logistic regression. We used existing WHO criteria (intended for under 5s) to define levels of severity and examined their performance in identifying those at increased risk of death.Results1832 children were diagnosed with pneumonia and 145 (7.9%) died. Severe pallor was strongly associated with mortality (adjusted OR (aOR) 8.06, 95% CI 4.72 to 13.75) as were reduced consciousness, mild/moderate pallor, central cyanosis and older age (>9 years) (aOR >2). Comorbidities HIV and severe acute malnutrition were also associated with death (aOR 2.31, 95% CI 1.39 to 3.84 and aOR 1.89, 95% CI 1.12 to 3.21, respectively). The presence of clinical characteristics used by WHO to define severe pneumonia was associated with death in univariate analysis (OR 2.69). However, this combination of clinical characteristics was poor in discriminating those at risk of death (sensitivity: 0.56, specificity: 0.68, and area under the curve: 0.62).ConclusionChildren >5 years have high inpatient pneumonia mortality. These findings also suggest that the WHO criteria for classification of severity for children under 5 years do not appear to be a valid tool for risk assessment in this older age group, indicating the urgent need for evidence-based clinical guidelines for this neglected population.

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Section: Discussionmentioning

confidence: 91%

Risk factors for death among children aged 5–14 years hospitalised with pneumonia: a retrospective cohort study in Kenya

et al. 2019

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“…The large studies of the viral etiology of pneumonia conducted in recent years [24] , [25] , [33] , [34] represent a major leap forward in our knowledge of what causes lower respiratory tract disease. In these studies influenza has been consistently detected in a substantial proportion of pneumonia cases, but estimates of incidence based on these data are often lower than expected.…”

Section: Discussionmentioning

confidence: 99%

The risk of lower respiratory tract infection following influenza virus infection: A systematic and narrative review

Malosh

Martin

Ortiz

et al. 2018

Vaccine

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BackgroundLower respiratory tract infections (LRTI) are a major cause of morbidity and mortality worldwide, particularly in young children and older adults. Influenza is known to cause severe disease but the risk of developing LRTI following influenza virus infection in various populations has not been systematically reviewed. Such data are important for estimating the impact specific influenza vaccine programs would have on LRTI outcomes in a community. We sought to review the published literature to determine the risk of developing LRTI following an influenza virus infection in individuals of any age.Methods and findingsWe conducted a systematic review to identify prospective studies that estimated the incidence of LRTI following laboratory-confirmed influenza virus infection. We searched PubMed, Medline, and Embase databases for relevant literature. We supplemented this search with a narrative review of influenza and LRTI. The systematic review identified two prospective studies that both followed children less than 5 years. We also identified one additional pediatric study from our narrative review meeting the study inclusion criteria. Finally, we summarized recent case-control studies on the etiology of pneumonia in both adults and children.ConclusionsThere is a dearth of prospective studies evaluating the risk of developing LRTI following influenza virus infection. Determining the burden of severe LRTI that is attributable to influenza is necessary to estimate the benefits of influenza vaccine on this important public health outcome. Vaccine probe studies are an efficient way to evaluate these questions and should be encouraged going forward.

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“…Few studies have systematically identified the contributions of both bacteria and viruses to acute respiratory tract infections in adults. Most have been conducted among pneumonia patients in high-income countries [3][4][5][6][7][8], among children [9], or have used limited diagnostic testing [10]; only one meta-analysis has looked at viral etiologies of acute respiratory tract infections in adults across multiple countries [11]. Studies in resource-rich countries may not be applicable to low-and middle-income countries due to differences in pathogen prevalence and variations in risk factors for disease (e.g., hygiene, access to clean water, malnutrition, crowding, HIV prevalence, health care access, vaccination rates, air pollution) among the populations.…”

Section: Introductionmentioning

confidence: 99%

The epidemiology and estimated etiology of pathogens detected from the upper respiratory tract of adults with severe acute respiratory infections in multiple countries, 2014–2015

et al. 2020

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Introduction Etiology studies of severe acute respiratory infections (SARI) in adults are limited. We studied potential etiologies of SARI among adults in six countries using multi-pathogen diagnostics. Methods We enrolled both adults with SARI (acute respiratory illness onset with fever and cough requiring hospitalization) and asymptomatic adults (adults hospitalized with non-infectious illnesses, non-household members accompanying SARI patients, adults enrolled from

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PERCH in Perspective: What Can It Teach Us About Pneumonia Etiology in Children?

Cited by 10 publications

References 13 publications

Risk factors for death among children aged 5–14 years hospitalised with pneumonia: a retrospective cohort study in Kenya

Risk factors for death among children aged 5–14 years hospitalised with pneumonia: a retrospective cohort study in Kenya

The risk of lower respiratory tract infection following influenza virus infection: A systematic and narrative review

The epidemiology and estimated etiology of pathogens detected from the upper respiratory tract of adults with severe acute respiratory infections in multiple countries, 2014–2015

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