Approach to Identifying Causative Pathogens of Community-Acquired Pneumonia in Children Using Culture, Molecular, and Serology Tests.

Yan Mardian,Dewi Lokida,Nurhayati Lukman,Helmia Farida,Herman Kosasih,Ahnika Kline,Adhella Menur Naysilla,Muhammad Karyana,Chuen-Yen Lau,Abu Tholib Aman

doi:10.3389/fped.2021.629318

Abstract

Determining the causative pathogen(s) of community-acquired pneumonia (CAP) in children remains a challenge despite advances in diagnostic methods. Currently available guidelines generally recommend empiric antimicrobial therapy when the specific etiology is unknown. However, shifts in epidemiology, emergence of new pathogens, and increasing antimicrobial resistance underscore the importance of identifying causative pathogen(s). Although viral CAP among children is increasingly recognized, distinguishing viral from bacterial etiologies remains difficult. Obtaining high quality samples from infected lung tissue is typically the limiting factor. Additionally, interpretation of results from routinely collected specimens (blood, sputum, and nasopharyngeal swabs) is complicated by bacterial colonization and prolonged shedding of incidental respiratory viruses. Using current literature on assessment of CAP causes in children, we developed an approach for identifying the most likely causative pathogen(s) using blood and sputum culture, polymerase chain reaction (PCR), and paired serology. Our proposed rules do not rely on carriage prevalence data from controls. We herein share our perspective in order to help clinicians and researchers classify and manage childhood pneumonia.

Highlights

Pneumonia is the leading infectious cause of death amongst children worldwide
The World Health Organization (WHO) used these data to develop a clinical case definition for pneumonia, which deliberately increased sensitivity to ensure that all potential pneumonia cases would receive effective antibiotic therapy [5, 6]
The 2011 Pediatric Infectious Diseases Society/Infectious Diseases Society of America (IDSA/PIDS) guideline recommends narrowspectrum antibiotics for most children hospitalized with community-acquired pneumonia (CAP), and macrolides for presumed atypical pathogens [10]

Summary

INTRODUCTION

Pneumonia is the leading infectious cause of death amongst children worldwide. It accounts for more than 138 million new cases and almost one million deaths annually, mostly amongst children under 5 years old [1, 2]. Serology may identify infections missed by other methods such as culture and PCR [45] and could distinguish colonization since nasopharyngeal carriage does not cause seroconversion between paired sera [55]. A study in children over 2-years old throughout Asia demonstrated that a combination of paired serology, direct antigen and DNA tests increases diagnostic yield of atypical pathogens such as M. pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila [56]. For interpretation of paired serologic testing, the following are considered indicative of infection: (a) Initial detection of specific antibodies after a prior negative sample (seroconversion), or (b) A two to four-fold increase, depending on the test, in antibody titers in the convalescent specimen [47].

Laboratory methods

Findings

DATA AVAILABILITY STATEMENT