Community-acquired pneumonia in children — a changing spectrum of disease

Roux, David M le; Zar, Heather J.

doi:10.1007/s00247-017-3827-8

Cited by 112 publications

(104 citation statements)

References 79 publications

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“…In the Drakenstein Child Health Study in Africa, where pneumococcal vaccination is included in their national immunization programme, they found a strong association between RSV, B. pertussis and H. influenzae with pneumonia, and that H. Influenzae occurred most frequently [25]. In a review article by Zar et al, the authors highlighted the changing disease spectrum of pneumonia in childhood, particularly the reducing prevalence of S. pneumoniae and Hib amid widespread use of vaccination [39]. In a large prospective study in India, S. aureus was detected in about 7% of children admitted with a LRTI.…”

Section: Discussionmentioning

confidence: 99%

Bacterial pneumonia and its associated factors in children from a developing country: A prospective cohort study

et al. 2020

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Introduction Pneumonia in children is a common disease yet determining its aetiology remains elusive. Objectives To determine the a) aetiology, b) factors associated with bacterial pneumonia and c) association between co-infections (bacteria + virus) and severity of disease, in children admitted with severe pneumonia. Methods A prospective cohort study involving children aged 1-month to 5-years admitted with very severe pneumonia, as per the WHO definition, over 2 years. Induced sputum and blood obtained within 24 hrs of admission were examined via PCR, immunofluorescence and culture to detect 17 bacteria/viruses. A designated radiologist read the chest radiographs. Results Three hundred patients with a mean (SD) age of 14 (±15) months old were recruited. Significant pathogens were detected in 62% of patients (n = 186). Viruses alone were detected in 23.7% (n = 71) with rhinovirus (31%), human metapneumovirus (HMP) [22.5%] and respiratory syncytial virus (RSV) [16.9%] being the commonest. Bacteria alone was detected in 25% (n = 75) with Haemophilus influenzae (29.3%), Staphylococcus aureus (24%) and Streptococcus pneumoniae (22.7%) being the commonest. Co-infections were seen in 13.3% (n = 40) of patients. Male gender (AdjOR 1.84 [95% CI 1.10, 3.05]) and presence of crepitations (AdjOR 2.27 [95% CI 1.12, 4.60]) were associated with bacterial infection. C

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Section: Discussionmentioning

confidence: 99%

Bacterial pneumonia and its associated factors in children from a developing country: A prospective cohort study

et al. 2020

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“…Current case management guidelines maximize diagnostic sensitivity over specificity, potentially resulting in antibiotic overuse. 16 Existing research suggests that most fast-breathing pneumonia cases will resolve without antibiotic therapy. In a study evaluating fever etiology among outpatient children in Tanzania, the authors found that, in the absence of critical illness and malaria, most febrile children could be treated supportively without antibiotics.…”

Section: Introductionmentioning

confidence: 99%

Placebo vs Amoxicillin for Nonsevere Fast-Breathing Pneumonia in Malawian Children Aged 2 to 59 Months

Ginsburg

Mvalo²,

Nkwopara

et al. 2019

JAMA Pediatr

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Key Points Question Are antibiotics necessary for the treatment of nonsevere fast-breathing pneumonia in children? Findings In this double-blind, randomized clinical noninferiority trial that included 1126 HIV-uninfected children aged 2 to 59 months in a malaria-endemic region of Malawi, Africa, placebo treatment of nonsevere fast-breathing pneumonia was significantly inferior to 3 days of amoxicillin treatment with respect to treatment failure at day 4. Fast-breathing pneumonia resolved by day 4 in 93% of children without the use of the antibiotic. Meaning Without amoxicillin treatment, 7% of Malawian children with nonsevere fast-breathing pneumonia failed treatment by day 4, and treating 33 children with amoxicillin was necessary for 1 child to benefit.

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“…[54,55] In the current era of conjugate vaccines targeting Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae, there has been a shift in the spectrum of pathogens causing pneumonia, with viruses contributing to a greater proportion of severe LRTI episodes (evidence level Ib) and non-typable H. influenzae and S. aureus emerging as important bacterial pathogens. [48,49,[56][57][58][59][60]…”

Section: Aetiology Diagnosismentioning

confidence: 99%

Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines

Zar

Moore

Andronikou

et al. 2020

Afr J Thorac Crit Care Med

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Background. Pneumonia remains a major cause of morbidity and mortality amongst South African children. More comprehensive immunisation regimens, strengthening of HIV programmes, improvement in socioeconomic conditions and new preventive strategies have impacted on the epidemiology of pneumonia. Furthermore, sensitive diagnostic tests and better sampling methods in young children improve aetiological diagnosis. Objective. To produce revised guidelines for pneumonia in South African children under 5 years of age. Methods. The Paediatric Assembly of the South African Thoracic Society and the National Institute for Communicable Diseases established seven expert subgroups to revise existing South African guidelines focusing on: (i) epidemiology; (ii) aetiology; (iii) diagnosis; (iv) antibiotic management and supportive therapy; (v) management in intensive care; (vi) prevention; and (vii) considerations in HIV-infected or HIVexposed, uninfected (HEU) children. Each subgroup reviewed the published evidence in their area; in the absence of evidence, expert opinion was accepted. Evidence was graded using the British Thoracic Society (BTS) grading system. Sections were synthesized into an overall guideline which underwent peer review and revision. Recommendations. Recommendations include a diagnostic approach, investigations, management and preventive strategies. Specific recommendations for HIV infected and HEU children are provided. Validation. The guideline is based on available published evidence supplemented by the consensus opinion of SA paediatric experts. Recommendations are consistent with those in published international guidelines.

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Community-acquired pneumonia in children — a changing spectrum of disease

Cited by 112 publications

References 79 publications

Bacterial pneumonia and its associated factors in children from a developing country: A prospective cohort study

Bacterial pneumonia and its associated factors in children from a developing country: A prospective cohort study

Placebo vs Amoxicillin for Nonsevere Fast-Breathing Pneumonia in Malawian Children Aged 2 to 59 Months

Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines

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