Clinical and bacterial profile of pneumonia in 2 months to 5 years age children: a prospective study done in a tertiary care hospital

Abstract

Background: Pneumonia is one of the leading causes of mortality among under-five children contributing to 15% of deaths all over the world. More than 95% of all new cases of pneumonia in children less than 5 years occur in developing countries due to increased prevalence of under nutrition, inadequate coverage of vaccination, lack of exclusive breast feeding, illiteracy etc. Methods: A total 110 subjects with pneumonia aged 2 months to 5 years were included in the study. Pneumonia was diagnosed clinically and classified according to new guidelines of WHO. Nutrition history including breast feeding practices and immunization history was taken. Anthropometry recorded along with thorough clinical examination bacterial cultures of blood, sputum and nasopharyngeal aspirates were done. Chest X-ray was taken for all patients for confirmation. Results: Out of 110 total subjects, Sixty three cases (57.27%) belonged to the revised WHO classification of ‘pneumonia’ and 47 (42.72%) cases had ‘severe pneumonia’. Ninety cases (81.81%) were less than 3 years of age. The percentage of severe pneumonia was higher in children less than 3 years of age with p value <0.05. No statistical correlation was found between gender and the severity of pneumonia. Out of total subjects, 64 cases were malnourished with weight for age <3 rd percentile. 25 cases belonged to IAP Grade I PEM, 30 cases to Grade II, 7 cases to Grade III and 2 Children belonged to grade IV PEM. There is no correlation between the degree of malnutrition and severity of pneumonia. Severe pneumonia was observed in higher proportion in children who were not exclusively breast fed with p value <0.05. Out of 83 fully vaccinated children, 26 (31.32%) cases had severe pneumonia whereas out of 27 cases of not fully vaccinated group, 21 (77.7%) had severe pneumonia with significant P value <0.05. Twenty six (23.63%) blood samples and 34 (30.9%) sputum/ nasopharyngeal aspirates yielded positive bacterial growth. Common organisms were Staphylococcus aureus (18), Klebsiella (18), CONS (4), Acinetobacter (4) Citrobacter (3), Pseudomonas (1), MRSA (1) and Streptococcus pneumoniae (1). Conclusions: Lack of exclusive breast feeding till 6 months of age, Failure of complete immunization coverage, Child malnutrition, Infancy and toddler age are the risk factors for ‘severe pneumonia’. Staphylococcus aureus (18), Klebsiella (18), CoNS (4), Acinetobacter (4), Citrobacter (3) are the common organisms isolated from cultures of blood and sputum/naso pharyngeal aspirates.