Abstract
Community-acquired pneumonia (CAP) is an infectious disease caused by bacteria, viruses, or a combination of these infectious agents. The severity of the clinical manifestations of CAP varies significantly. Consequently, both the differentiation of viral from bacterial CAP cases and the accurate assessment and prediction of disease severity are critical for effectively managing individuals with CAP. To solve questionable cases, several biomarkers indicating the etiology and severity of CAP have been studied. Unfortunately, only a few studies have examined the roles of these biomarkers in pediatric practice. The main aim of this paper is to detail current knowledge regarding the use of biomarkers to diagnose and treat CAP in children, analyzing the most recently published relevant studies. Despite several attempts, the etiologic diagnosis of pediatric CAP and the estimation of the potential outcome remain unsolved problems in most cases. Among traditional biomarkers, procalcitonin (PCT) appears to be the most effective for both selecting bacterial cases and evaluating the severity. However, a precise cut-off separating bacterial from viral and mild from severe cases has not been defined. The three-host protein assay based on C-reactive protein (CRP), tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), plasma interferon-γ protein-10 (IP-10), and micro-array-based whole genome expression arrays might offer more advantages in comparison with former biomarkers. However, further studies are needed before the routine use of those presently in development can be recommended.
Highlights
In the past thirty years, the incidence of community-acquired pneumonia (CAP) in the pediatric population has significantly decreased worldwide, mainly because of the increasingly widespread use of effective means of prevention such as Haemophilus influenzae type b vaccine (Hibv) and pneumococcal conjugate vaccines (PCVs) [1,2]
Some of the biomarkers used for etiologic diagnosis in children with CAP have been tested to evaluate the disease severity in the same population
Interleukin-6 (IL-6) is the only one of 15 serum cytokines studied that is correlated with indicators of disease severity in childhood CAP, including lobar consolidation [52]
Summary
In the past thirty years, the incidence of community-acquired pneumonia (CAP) in the pediatric population has significantly decreased worldwide, mainly because of the increasingly widespread use of effective means of prevention such as Haemophilus influenzae type b vaccine (Hibv) and pneumococcal conjugate vaccines (PCVs) [1,2]. Estimates for 2015 have indicated that approximately 1 million children younger than 5 years of age have died from CAP worldwide, and the majority of these deaths have occurred in the developing world, mainly in South Asia and the sub-Saharan area [3]. In industrialized countries, where it has been calculated that, every year, a total number of approximately 4 million CAP cases are diagnosed, death occurs mainly in children with severe chronic underlying conditions, such as lung disease of prematurity, congenital heart disease, and immunosuppression [4]. Many of these pediatric CAPs are hospitalized, affecting the healthcare system. It has been estimated that, in the USA during 2010–2012, several years after the inclusion of Hibv and PCVs in the recommended pediatric immunization schedule, the annual pediatric hospitalization rate for CAP was 15.7 cases per 10,000 children, and the highest rate occurred among subjects younger than 2 years of age (62.2 cases per 10,000 children) [5]
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