Diagnostic features of community‐acquired pneumonia in children: what's new?

Chiappini, Elena; Venturini, Elisabetta; Galli, Luisa; Novelli, Vas; Martino, Maurizio de

doi:10.1111/apa.12502

Cited by 9 publications

(8 citation statements)

References 85 publications

(87 reference statements)

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“…Other studies found reduced peripheral oxygen concentration as one of several clinical features associated with a positive chest radiograph [ 7,25,26,30,31 ], while in our cohort with a high coverage of pneumococcal vaccination and with a large impact of viral etiology, this was the only clinical feature associated with a positive chest radiograph. In differentiating between etiologies in proven CAP, our findings are in line with previous literature; most clinical features did not distinguish significantly between viral, atypical, or bacterial pneumonia [ 6,20,22,27 ]. Only the presence of hypoxemia at inclusion was significantly associated with viral etiology.…”

Section: Logistic Regression Analyses and Test Characteristicssupporting

confidence: 91%

Clinical features and inflammatory markers in pediatric pneumonia: a prospective study

et al. 2017

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With relatively high specificity and likelihood ratio CRP, WBC count and hypoxemia may be beneficial in ruling in a positive chest radiograph in suspected pneumonia and bacterial etiology in proven pneumonia, but with low sensitivity, the clinical utility is limited. What is Known: • Pneumonia is recommended to be a clinical diagnosis, and neither clinical features nor inflammatory markers can reliably distinguish etiology. • The etiology of pneumonia has changed after routine pneumococcal conjugate vaccine. What is New: • High CRP and WBC counts were associated with infiltrates in children with suspected pneumonia and with bacterial infection in proven pneumonia. • In the post-pneumococcal vaccination era, viral etiology is expected, and in cases of pneumonia with low CRP and WBC counts, a watch-and-wait strategy for antibiotic treatment may be applied.

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Section: Logistic Regression Analyses and Test Characteristicssupporting

confidence: 91%

Clinical features and inflammatory markers in pediatric pneumonia: a prospective study

et al. 2017

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“…The additional signs evaluated by the physician (such as inflammation of the throat and palatine tonsils, and chest auscultation) are also non-specific and were not associated with SPn colonization in our study. Other researchers examined various possible features to aid in diagnosis of diseases caused by SPn: Chiappini et al found no associations of signs and symptoms with aetiology of pneumonia [ 33 ], NP culture results were not found to be predictive of AOM by Casey et al [ 14 ], and Shaikh et al extensively studied the signs and symptoms in order to differentiate sinusitis and uncomplicated upper respiratory infections and found only green nasal discharge and sleep disturbances to be associated with radiological findings consistent with sinusitis [ 34 ]. These findings signify that the difficulties in distinguishing bacterial from viral causes of RTI remain high.…”

Section: Discussionmentioning

confidence: 99%

The influence of Streptococcus pneumoniae nasopharyngeal colonization on the clinical outcome of the respiratory tract infections in preschool children

et al. 2015

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BackgroundStreptococcus pneumoniae (SPn) is an important pathogen causing a variety of clinical manifestations. The effects of SPn nasopharyngeal colonization on respiratory tract infections are poorly studied. We evaluated the association of SPn colonization with features of respiratory tract infections.MethodsChildren under the age of 6 years who visited a primary care physician because of respiratory tract infections were enrolled in the study. History was taken, children were clinically assessed by the physician, and nasopharyngeal swabs were obtained and cultured for SPn. Positive samples were serotyped. Associations of SPn colonization with clinical signs and symptoms, recovery duration, absence from day care centre, frequencies of specific diagnoses, and treatment with antimicrobials were evaluated.ResultsIn total 900 children were enrolled. The prevalence of SPn colonization was 40.8 % (n = 367). There were minor differences between male and female subjects (199 of 492, 40.4 % vs 168 of 408, 41.2 %, p = 0.825). Children with and without siblings had similar colonization rates (145 of 334, 43.4 % vs 219 of 562, 39.0 %, p = 0.187). Clinical signs and symptoms were not associated with SPn colonization. Children colonized with SPn had longer recovery duration compared to non-colonized children (114 of 367, 31.1 % vs 98 of 533, 18.4 %, p < 0.001) and were longer absent from day care (270 of 608, 44.4 % vs 94 of 284, 33.1 %, p = 0.001). Pneumonia, sinusitis, and acute otitis media were more frequently diagnosed in children colonized with SPn. Children attending day care centres had significantly higher prevalence of SPn colonization (270 of 367, 44.4 % vs 338 of 533, 33.1 %, p = 0.001). Children with pneumonia, sinusitis and acute otitis media were more frequently treated with antimicrobials than children with other diagnoses.ConclusionsSPn nasopharyngeal colonization has a negative impact on the course of respiratory tract infection, likely because of SPn being the cause of the disease or a complicating factor. It is also associated with and may be responsible for higher frequencies of bronchitis, pneumonia, acute otitis media, sinusitis and the need of antimicrobial treatment.

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“…The paper by Chiappini et al. in this issue clearly shows that a main problem in the clinical approach to community‐acquired pneumonia in infants and children is the substantial difficulty in discriminating bacterial and viral aetiology. This distinction is impossible based on clinical observations and age .…”

Section: Preludementioning

confidence: 99%

“…Diagnoses of bacterial pneumonia that are based on culture methods tend to lack sensitivity, especially after antibiotic therapy, particularly in cases of invasive pneumococcal disease . By contrast, real‐time polymerase chain reaction (RT‐PCR) is sensitive and specific .…”

Section: Preludementioning

confidence: 99%

Pneumonia in children: more shadows than lights

Martino

Chiappini

2013

Acta Paediatrica

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Diagnostic features of community‐acquired pneumonia in children: what's new?

Abstract: Antibiotic overuse could make it difficult to differentiate viral and bacterial causes. Molecular methods provide promising tools for diagnosing infection by atypical bacteria, but are expensive and should be used selectively.

Cited by 9 publications

References 85 publications

Clinical features and inflammatory markers in pediatric pneumonia: a prospective study

Clinical features and inflammatory markers in pediatric pneumonia: a prospective study

The influence of Streptococcus pneumoniae nasopharyngeal colonization on the clinical outcome of the respiratory tract infections in preschool children

Pneumonia in children: more shadows than lights

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