Characteristics of<i>Streptococcus pneumoniae</i>and Atypical Bacterial Infections in Children 2–5 Years of Age with Community‐Acquired Pneumonia

Esposito, Susanna; Bosis, Samantha; Cavagna, Roberta; Faelli, Nadia; Begliatti, Enrica; Marchisio, Paola; Blasi, Francesco; Bianchi, Ciro; Principi, Nicola

doi:10.1086/344191

Cited by 99 publications

(78 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Recently published data have confirmed the prevalence of atypical pathogens in paediatric CAP patients [66], highlighting their significant role in the pathogenesis of the disease and the need to reassess antibiotic therapy with b-lactam agents. In 196 children with CAP aged 2-5 yrs, S. pneumoniae infections were diagnosed in 24.5% of patients, atypical bacterial infections in 23.5% of patients, and mixed S. pneumoniae and atypical bacterial infections in 8.2% of children.…”

Section: Community-acquired Pneumoniamentioning

confidence: 92%

See 1 more Smart Citation

Atypical pathogens and respiratory tract infections

Blasi¹

2004

European Respiratory Journal

109

View full text Add to dashboard Cite

The atypical respiratory pathogens Chlamydia pneumoniae, Mycoplasma pneumoniae and Legionella pneumophila are now recognised as a significant cause of acute respiratory-tract infections, implicated in community-acquired pneumonia, acute exacerbations of chronic bronchitis, asthma, and less frequently, upper respiratory-tract infections.Chronic infection with C. pneumoniae is common among patients with chronic obstructive pulmonary disease and may also play a role in the natural history of asthma, including exacerbations. The lack of a gold standard for diagnosis of these pathogens still handicaps the current understanding of their true prevalence and role in the pathogenesis of acute and chronic respiratory infections.While molecular diagnostic techniques, such as polymerase chain reaction, offer improvements in sensitivity, specificity and rapidity over culture and serology, the need remains for a consistent and reproducible diagnostic technique, available to all microbiology laboratories.Current treatment guidelines for community-acquired pneumonia recognise the importance of atypical respiratory pathogens in its aetiology, for which macrolides are considered suitable first-line agents. The value of atypical coverage in antibiotic therapy for acute exacerbations of chronic bronchitis and exacerbations of asthma is less clear, while there is no evidence to suggest that atypical pathogens should be covered in antibiotic treatment of upper respiratory-tract infections. The term "atypical pathogen" most commonly refers to Chlamydia pneumoniae, Mycoplasma pneumoniae and Legionella pneumophila. Once believed to be of little clinical significance, a wealth of data accumulated over the past decade suggests that these are important respiratory pathogens in a wide range of respiratory-tract infections (RTIs) and are capable of causing severe, as well as mild-to-moderate, illness.Although the role of atypical pathogens [1], and of C. pneumoniae in particular [2], has been reviewed previously, there has been little focus on appropriate coverage of these pathogens in treatment decisions for patients with RTIs. In addressing this issue, this review examines the role of atypical pathogens in the aetiology of upper and lower RTIs, in both adults and children, and discusses the value of appropriate coverage of these pathogens in empirical antibiotic prescribing.

show abstract

Section: Community-acquired Pneumoniamentioning

confidence: 92%

“…Studies have shown that the inclusion of a macrolide in treatment regimens can improve clinical outcome in children with lower RTIs due to atypical pathogens [65], including those with CAP [66], in whom it is especially difficult to determine the microbial aetiology.…”

Section: Community-acquired Pneumoniamentioning

confidence: 99%

Atypical pathogens and respiratory tract infections

Blasi¹

2004

European Respiratory Journal

109

View full text Add to dashboard Cite

show abstract

Section: Methodsmentioning

confidence: 99%

“…Each acute and convalescent serum sample was tested after absorption for IgM and IgG antibodies to M. pneumoniae (ELISA; Pantec), and IgM, IgA and IgG antibodies to C. pneumoniae (microimmunofluorescence; Labsystems) as described previously (Wang & Grayston, 1970;Esposito et al, 2002a). Nasopharyngeal aspirates were evaluated for the presence of M. pneumoniae and C. pneumoniae DNA by using validated nested PCR for both pathogens, as described previously (Tong & Sillis, 1993;Abele-Horn et al, 1998;Blasi et al, 1999;Esposito et al, 2002a).The nested PCR technique for M. pneumoniae was developed by AbeleHorn et al (1998), and that for C. pneumoniae by Tong & Sillis (1993); both techniques have been found to correlate well with cultures (Tong & Sillis, 1993; Abele-Horn et al, 1998). To avoid risk of contamination, sample preparation, PCR amplification and product analysis were performed in separate rooms.…”

mentioning

confidence: 99%

Aetiology of acute pharyngitis: the role of atypical bacteria

Esposito

Blasi

Bosis

et al. 2004

Journal of Medical Microbiology

Self Cite

View full text Add to dashboard Cite

In order to establish the role of atypical bacteria and compare characteristics of different infectious agents in acute pharyngitis, 127 patients with acute pharyngitis (66 males; median age, 5 . 33 years; range, 6 months to 14 years) and 130 healthy subjects of similar sex and age were studied. Serology with paired samples and PCR on nasopharyngeal aspirates and throat cultures were used to identify bacteria and viruses. Viruses were identified in 43 patients (33 . 8 %) and five controls (3 . 8 %; P , 0 . 0001), potential bacterial pathogens in 34 patients (26 . 8 %) and 26 controls (20 %; P ¼ 0 . 256) and mixed viral/bacterial pathogens in 26 patients (20 . 5 %) and none of the controls (P , 0 . 0001). The main aetiological agents were adenovirus, respiratory syncytial virus (RSV), Mycoplasma pneumoniae, Streptococcus pyogenes and Chlamydia pneumoniae. M. pneumoniae was the agent found most frequently as a single pathogen. A history of recurrent pharyngitis, having older siblings and a negative outcome were significantly more common among patients with acute M. pneumoniae infection than among those with infections due to other pathogens or healthy controls. This study demonstrates that: (i) adenovirus and RSV have a prominent role in acute pharyngitis; (ii) S. pyogenes is found frequently, but it is not possible to distinguish simple carriers from patients with a true infection; (iii) M. pneumoniae appears to be able to cause acute pharyngitis per se; and (iv) C. pneumoniae seems to be mainly a co-pathogen. To avoid the risk of an incorrect therapeutic approach, simple laboratory investigations that allow rapid identification of M. pneumoniae infections are urgently needed. INTRODUCTIONAcute pharyngitis is one of the most common childhood illnesses to be diagnosed in an outpatient setting (Bisno et al., 1997(Bisno et al., , 2002Bisno, 2001). Viruses and Streptococcus pyogenes are considered to be the most frequent causes of this disease, but particular attention is usually given only to streptococcal cases, as they may be followed by severe early and late complications and are the only ones for which antibiotic treatment is definitely indicated (Bisno et al., 1997(Bisno et al., , 2002Bisno, 2001).It has recently been demonstrated that a significant part of non-streptococcal acute pharyngitis may be associated with Mycoplasma pneumoniae and/or Chlamydia pneumoniae infection, but it has not been established whether these atypical bacteria act simply as co-pathogens or as primary aetiological agents, nor is it known what the outcome of such infections is when they are not treated with antibiotics Esposito et al., 2002b). Definition of the real role of M. pneumoniae and C. pneumoniae in causing acute pharyngitis would be useful for deciding the best diagnostic and therapeutic approach. If these bacteria are primary causes of pharyngitis, and if the disease is likely to have a more complicated course unless treated with adequate antimicrobial agents, some cases that are not usually treated (as they are considered t...

show abstract

“…The evidence indicates that clinical and radiological findings cannot be used to reliably discriminate between CAP of viral, bacterial or atypical aetiology [169,170]. Rapid isolation of bacterial pathogens and the prescription of appropriate narrow-spectrum antibiotics are not feasible in most circumstances.…”

Section: Current Unlicensed and Off-label Usementioning

confidence: 99%

Respiratory medicines for children: current evidence, unlicensed use and research priorities

Smyth¹,

Barbato²,

Beydon³

et al. 2009

European Respiratory Journal

View full text Add to dashboard Cite

This European Respiratory Society task force has reviewed the evidence for paediatric medicines in respiratory disease occurring in adults and children. We describe offlicence use, research priorities and ongoing studies.Off-licence and off-label prescribing in children is widespread and potentially harmful. Research areas in asthma include novel formulations and regimens, and individualised prescribing. In cystic fibrosis, future studies will focus on screened infants and robust outcome measures are needed. Other areas include new enzyme and antibiotic formulations and the basic defect. Research into pneumonia should include evaluation of new antibacterials and regimens, rapid diagnostic tests and, in pleural infection, antibiotic penetration, fibrinolytics and surveillance. In uncommon conditions, such as primary ciliary dyskinesia, congenital pulmonary abnormalities or neuromuscular disorders, drugs indicated for other conditions (e.g. dornase alfa) are commonly used and trials are needed. In neuromuscular disorders, the b-agonists may enhance muscle strength and are in need of evaluation. Studies of antibiotic prophylaxis, immunoglobulin and antifungal drugs are needed in immune deficiency.We hope that this summary of the evidence for respiratory medicines in children, highlighting gaps and research priorities, will be useful for the pharmaceutical industry, the paediatric committee of the European Medicines Agency, academic investigators and the lay public.

show abstract

Characteristics ofStreptococcus pneumoniaeand Atypical Bacterial Infections in Children 2–5 Years of Age with Community‐Acquired Pneumonia

Cited by 99 publications

References 51 publications

Atypical pathogens and respiratory tract infections

Atypical pathogens and respiratory tract infections

Aetiology of acute pharyngitis: the role of atypical bacteria

Respiratory medicines for children: current evidence, unlicensed use and research priorities

Contact Info

Product

Resources

About