Community-acquired pneumonia in children

Abstract

Community-acquired pneumonia (CAP) remains a frequent cause of morbidity and mortality worldwide even in industrialised countries, and its incidence is highest among children aged <5 years. Over the last two years, three international guidelines have been updated with new evidence concerning the incidence, aetiology and management of childhood CAP, but there are still some major problems in standardisation. The main aim of this review is to consider the available data concerning the aetiology, diagnosis, evaluation of severity, and treatment of paediatric CAP. Analysis of the literature shows that there are a number of unanswered questions concerning the management of CAP, including its definition, the absence of a paediatric CAP severity score, the difficulty of identifying its aetiology, the emergence of resistance of the most frequent respiratory pathogens to the most widely used anti-infectious agents, and the lack of information concerning the changes in CAP epidemiology following the introduction of vaccines against respiratory pathogens. More research is clearly required in various areas, and further efforts are needed to increase vaccination coverage with the already available vaccines in order to reduce the occurrence of the disease.

Can Serum Surfactant Protein D Levels be used as an Effective Factor Instead of Clinical Severity Scores of Pneumonia in Pediatric Emergency Departments?

“…Despite advanced diagnostic tests, a clinical algorithm has not yet been developed to clarify etiology in the child age group. Specifically, high coinfection rates (30 to 45%) accompanying viral CAP cases increase the difficulty of this situation (4,5). Unclarified CAP etiology is critical, since it leads to unnecessary use of antibiotics, elevated resistance, and increased health care expenses.…”

“…Bacterial agents are a less significant factor (10%-40%) (3). However, many studies published in the last ten years have reported that mixed viral/bacterial infections play a role in 45% of pediatric CAP cases (4). Similar signs and symptoms caused by these agents result in the failure of radiological findings to differentiate the agents and difficulties in the routine practice of invasive interventions, such as hemoculture, bronchoalveolar lavage (BAL), and lung needle biopsy.…”

“…Similar signs and symptoms caused by these agents result in the failure of radiological findings to differentiate the agents and difficulties in the routine practice of invasive interventions, such as hemoculture, bronchoalveolar lavage (BAL), and lung needle biopsy. Complications resulting from these interventions have encouraged clinicians to research diagnostic and prognostic biochemical indicators in CAP cases (4,5). Furthermore, the unnecessary use of antibiotics due to failure to perform invasive interventions based on viral and bacterial pneumonia differentiation leads to financial burdens.…”

Lungenerkrankungen im Kindesalter

“…Zur Unterscheidung zwischen viralen und bakteriellen Pneumonien hilft das Labor (Leukozytenzahl, Differenzialblutbild, Blutsenkungsgeschwindigkeit, C-reaktives Protein [CRP]) oft nur wenig weiter [5]. Allerdings wird Procalcitonin mittlerweile eine gute Aussagekraft bzgl.…”

“…der Fragen, ob eine bakterielle Pneumonie vorliegt und wie lange diese antibiotisch zu behandeln ist, zugeschrieben [12]. Die Identifizierung des auslösen-den Pathogens gestaltet sich bei Kindern ebenfalls kompliziert, da Sputumproben nur von größeren Kindern gewonnen werden können [5]. Nasen-und Rachenabstriche von jüngeren Kindern sind ungeeignet, da diese häufig mit pneumonieauslösenden Bakterien besiedelt sind, diese jedoch keine klinische Relevanz haben [20].…”