Abstract
BackgroundThe aim of this case–control study was to analyse the clinical characteristics of children with recurrent community-acquired pneumonia (rCAP) affecting different lung areas (DLAs) and compare them with those of children who have never experienced CAP in order to contribute to identifying the best approach to such patients.MethodsThe study involved 146 children with ≥2 episodes of radiographically confirmed CAP in DLA in a single year (or ≥3 episodes in any time frame) with radiographic clearing of densities between occurrences, and 145 age- and gender-matched controls enrolled in Milan, Italy, between January 2009 and December 2012. The demographic and clinical characteristics of the cases and controls were compared, and a comparison was also made between the cases with rCAP (i.e. ≤3 episodes) and those with highly recurrent CAP (hrCAP: i.e. >3 episodes).ResultsGestational age at birth (p = 0.003), birth weight (p = 0.006), respiratory distress at birth (p < 0.001), and age when starting day care attendance (p < 0.001) were significantly different between the cases and controls, and recurrent infectious wheezing (p < 0.001), chronic rhinosinusitis with post-nasal drip (p < 0.001), recurrent upper respiratory tract infections (p < 0.001), atopy/allergy (p < 0.001) and asthma (p < 0.001) were significantly more frequent. Significant risk factors for hrCAP were gastroesophageal reflux disease (GERD; p = 0.04), a history of atopy and/or allergy (p = 0.005), and a diagnosis of asthma (p = 0.0001) or middle lobe syndrome (p = 0.001). Multivariate logistic regression analysis, adjusted for age and gender, showed that all of the risk factors other than GERD and wheezing were associated with hrCAP.ConclusionsThe diagnostic approach to children with rCAP in DLAs is relatively easy in the developed world, where the severe chronic underlying diseases favouring rCAP are usually identified early, and patients with chronic underlying disease are diagnosed before the occurrence of rCAP in DLAs. When rCAP in DLAs does occur, an evaluation of the patients’ history and clinical findings make it possible to limit diagnostic investigations.
Highlights
The aim of this case–control study was to analyse the clinical characteristics of children with recurrent community-acquired pneumonia affecting different lung areas (DLAs) and compare them with those of children who have never experienced CAP in order to contribute to identifying the best approach to such patients
We recorded any underlying diseases possibly associated with CAP that had been diagnosed during hospitalisation or a visit to our outpatient clinic: i.e. oromotor incoordination and swallowing dysfunction predisposing to aspiration syndrome [11]; immune disorders, including atopy/allergy and primary and acquired immunodeficiency syndrome [12,13]; congenital heart defects [14]; lung and airway problems such as chronic rhinosinusitis with post-nasal drip [15], primary ciliary dyskinesia [16], recurrent wheezing [17,18], bronchial asthma [13] or middle lobe syndrome [19]; gastroesophageal reflux disease (GERD) [20]; and overweight or obesity [21]
GERD and obesity were relatively common in both groups, but some conditions involving the respiratory tract were more frequent in the children with recurrent community-acquired pneumonia (rCAP)
Summary
The aim of this case–control study was to analyse the clinical characteristics of children with recurrent community-acquired pneumonia (rCAP) affecting different lung areas (DLAs) and compare them with those of children who have never experienced CAP in order to contribute to identifying the best approach to such patients. RCAP affecting multiple lobes or different areas of the same lobe may be associated with a wide range of more or less severe clinical problems that could per se increase the risk of lung infection. As some of these can only be identified using specific laboratory and/or instrumental methods, diagnosing and treating patients with rCAP in DLAs can be complicated and expensive, and is not always efficacious
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