Abstract
The aetiology of community-acquired pneumonia (CAP) is not easy to establish. As lung ultrasound (LUS) has already proved to be an excellent diagnostic tool for CAP, we analysed its usefulness for discriminating between the aetiologically different types of CAP in children. We included 147 children hospitalized because of CAP. LUS was performed in all patients at admission, and follow-up LUS was performed in most patients. LUS-detected consolidations in viral CAP were significantly smaller, with a median diameter of 15 mm, compared to 20 mm in atypical bacterial CAP (p = 0.05) and 30 mm in bacterial CAP (p < 0.001). Multiple consolidations were detected in 65.4% of patients with viral CAP and in 17.3% of patients with bacterial CAP (p < 0.001). Bilateral consolidations were also more common in viral CAP than in bacterial CAP (51.9% vs. 8.0%, p < 0.001). At follow-up, a regression of consolidations was observed in 96.6% of patients with bacterial CAP and in 33.3% of patients with viral CAP (p < 0.001). We found LUS to be especially suitable for differentiating bacterial CAP from CAP due to other aetiologies. However, LUS must be interpreted in light of clinical and laboratory findings.
Highlights
Childhood community-acquired pneumonia (CAP) is a common infection of the lower respiratory tract and the single most important cause of mortality in preschool children in the developing world[1]
Blood culture was positive in only 4 patients (5.3% of all subjects with bacterial CAP), and Streptococcus pneumoniae was isolated in all cases
We have shown that Lung ultrasound (LUS) is a sensitive tool for detection and can contribute to the aetiological diagnosis of CAP in children
Summary
Childhood community-acquired pneumonia (CAP) is a common infection of the lower respiratory tract and the single most important cause of mortality in preschool children in the developing world[1]. Infection with M. pneumoniae often radiologically mimics classic bacterial CAP, presenting with alveolar infiltrate or even small pleural effusion[6,16]. The advantages of LUS are as follows: no ionizing radiation, lower cost, the possibility of follow-up examination, the ability to monitor the effect of therapy, and better patient cooperation[21,22]. This diagnostic technique is accessible, portable, fast, easy to learn, and can be used immediately as a point-of-care method. By using LUS, it is possible to observe many pathological lung patterns associated with pneumonia, such as consolidation, pleural effusion, and interstitial syndrome. Hyperechoic and dynamic air bronchograms detected within the area of consolidation, is the hallmark of pneumonia[17,23]
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