Underlying Causes of Recurrent Pneumonia in Turkish Children in a University Hospital

Abstract

The aim of this study was to determine the relative frequency of underlying illnesses for recurrent pneumonia in children. Children who had two or more episodes of pneumonia per year, or three or more episodes in a lifetime were investigated retrospectively at Ankara University Medical School, Department of Pediatric Infectious Diseases, between January 1997 and October 2002. Out of 788 children hospitalized for pneumonia, 71 (9 per cent) met the criteria for recurrent pneumonia. An underlying illness was demonstrated in 60 patients (85 per cent). In this group, the underlying illness was diagnosed prior to pneumonia in 11 patients (18.3 per cent), during the first episode in 12 patients (20 per cent), and during recurrence in 37 patients (61.7 per cent). Underlying diseases were bronchial asthma (32 per cent), gastroesophageal reflux (15 per cent), immune disorders (10 per cent), congenital heart defects (9 per cent), anomalies of the chest and lung (6 per cent), bronchopulmonary dysplasia (4 per cent), cystic fibrosis (3 per cent), tuberculosis (3 per cent), and aspiration syndrome (3 per cent). No predisposing illness could be demonstrated in 11 patients (15 per cent). In conclusion, approximately one-tenth of hospitalized children with pneumonia in our hospital had recurrent pneumonia. Most of these children had an underlying illness, which was demonstrated by intensive investigation. Bronchial asthma in children aged more than 2 years and gastroesophageal reflux in children aged less than 1 year were the most common underlying illnesses for recurrent pneumonia.

Recurrent Pneumonia in Children: A Reasoned Diagnostic Approach and a Single Centre Experience

“…Recurrent pneumonia (RP) is defined as at least two episodes of pneumonia in one year or three episodes ever, with intercritical radiographic clearing of densities [3]. Incidence data indicate that RP occurs in 7.7%–9% of all children with CAP [4,5,6,7,8,9]. As a result, RP represents a frequent presenting manifestation in the general pediatric practice and is a very common reason for referral to pediatric chest physicians [4].…”

“…Data on the underlying causes of RP in children come from retrospective case series [4,5,6,7,8,9,10], and prospective studies are lacking. The methodology for prospective studies of RP implies the recruitment of a large cohort of children, a thorough investigation of the cases, and the generation of predictive indices for confirming or excluding the diagnosis.…”

A boy with recurrent pneumonia

“…The patient meets the criteria for recurrent pneumonia (RP) which is defined as o2 episodes in a single year or o3 episodes ever, with clearing of x-ray densities between episodes [1]. Recurrent pneumonia occurs in 7.7-9% of all children with pneumonia [2][3][4][5].…”

“…Older children with asthma may develop recurrent chest infiltrates/ pneumonias [3,4,10]. In a study of 125 asthmatic children, 14 of them experienced 70 episodes of recurrent pneumonia [11].…”

“…In the USA, 40% of patients with RP had asthma, 10% aspiration and 5% immunodeficiency syndromes [10]. In Turkey, the most common underlying causes of RP were asthma (32%), gastro-oesophageal reflux (15%), and in children younger than 2 yrs old, immunodeficiency (10%) and aspiration syndromes (3%) [4]. In contrast, in series from Canada [3] and India [5], aspiration was the leading cause [6].…”