Acute Community-acquired Pneumonia Research Articles

Community-acquired pneumonia: use of clinical characteristics of acutely admitted patients for the development of a diagnostic model – a cross-sectional multicentre study

ObjectivesThis study aimed to describe the clinical characteristics of adults with suspected acute community-acquired pneumonia (CAP) on hospitalisation, evaluate their prediction performance for CAP and compare the performance of the...

ЭТИОЛОГИЧЕСКАЯ СТРУКТУРА ОСТРОЙ ВНЕБОЛЬНИЧНОЙ ПНЕВМОНИИ У ДЕТЕЙ

Background. Difficulties in the etiological diagnosis of pneumonia in children are due to its polyetiology. Pneumonia can be caused by both typical bacterial agents and atypical pathogens. The condition of frequently ill children is characterized by a combination of several pathogens, in particular, a viral-bacterial association. The frequent use of antibacterial therapy in a group of frequently ill children should be taken into account when choosing initial therapy in a hospital. Objective. To establish the etiological structure of acute community-acquired pneumonia in frequently ill children. Material and methods. 180 children (1st group 50/180 - children belonged to the group of frequently ill children, 2nd group 130/180 - children did not belong to the group of frequently ill children) with a diagnosis of "acute communityacquired pneumonia" were examined in accordance with the protocol with assessment of the etiological structure. Results. The total number of frequently ill children was 27.8% (50/180). The somatic type of “truly” frequently ill children occurs 2.3 times more often (RR=2.33; 95% CI 1.4720-3.6986; p=0.0003) than the otorhinolaryngological type. The infection index in patients from the group of frequently ill children is 3.0 times higher (p=0.0002), the resistance index is 3.5 times higher (p=0.0012), compared with the group of infrequently ill children. In the group of frequently ill children, there was a higher frequency of acute illnesses during the year and the development of complications from acute respiratory infections. Conclusion. The causative agent of pneumonia was diagnosed in every third patient, in the remaining patients the causative agent was undifferentiated, while atypical pathogens (Chlamydophila рneumoniae and Mycoplasma рneumoniae) were diagnosed 4.7 times more often (RR=4.773; 95% CI 2.9620-7.6901; p=0.0024) than grampositive, gram-negative flora.

Clinical case of COVID-19 in an HIV-infected teenager

The problem of non-smooth course of COVID-19 in people with severe comorbidities is topical. The greatest number of deaths from a new coronavirus infection was noted in the presence of such diseases as: obesity, chronic bronchopulmonary, cardiovascular diseases, HIV infection, diabetes mellitus, oncohematology, etc. Due to the focus of the healthcare system on the COVID-19 pandemic, less attention is paid to the fight against the immunodeficiency virus, despite the fact that the epidemiological situation with HIV infection in the Russian Federation continues to be tense. Individuals with HIV infection may be at increased risk of complications and death associated with COVID-19. The stage of HIV infection, indicators of the immune status, viremia, and taking antiretroviral therapy correlate with the severity of the course of COVID-19/HIV and have prognostic value. A clinical observation of the course of a new coronavirus infection in a 15-year-old teenager born to an HIV infected mother (who hid her HIV status at the time of hospitalization of a child) who was not at a dispensary observation at the AIDS Center was presented. The child was hospitalized with a new coronavirus infection (COVID-19), complicated: acute community-acquired (interstitial) bilateral pneumonia. The low index body mass of the child, the presence of concomitant pathology, the non-smooth course of the disease made it possible to suspect the patient of an immunodeficiency condition and identify concomitant HIV infection in the secondary disease stage (4B), the progression phase with the absence of antiretroviral therapy. Conclusion: the non-smooth course and severity of the disease were mainly due to secondary infections pathology. Severe immunosuppression detected in a child due to HIV infection contributed to the long-term persistence of the SARS-CoV-2 virus. In this case, it was not established that HIV infection in the patient was a factor predisposing to the severe course of COVID-19 and contributing to a prognostically unfavorable outcome. Complex therapy including antiretroviral therapy prevented further progression of immunosuppression and led to recovery from new coronavirus infection and management of comorbidity. The increase in the number of HIV-infected persons in the late stages of infection, often detected by chance, only during hospitalization, presents difficulties for therapy due to late diagnosis, the presence of a combined secondary pathology and the severity of its course against the background of low immune status parameters.

Актуальные вопросы диагностики и выбора эффективной антибактериальной терапии острого бронхита и внебольничной пневмонии у детей

Введение. Наиболее частыми формами инфекций нижних дыхательных путей в практике врача являются острый бронхит и внебольничная пневмония. Врачу приходится принимать решение о тактике ведения таких пациентов с учетом клинической картины и результатов обследования. Внебольничная пневмония является распространенным и потенциально угрожающим жизни заболеванием органов дыхания. Острота проблемы состоит в том, что в периоды эпидемий гриппа или других респираторных вирусных инфекций активируется и Streptococcus рneumoniae, что приводит к росту заболеваемости внебольничной пневмонией. В последние годы этиология пневмонии значительно расширилась, и среди ее причин важное место, помимо бактерий, стали занимать пневмотропные вирусы (новый коронавирус SARS-CoV-2, MERS, вирусы гриппа А, в т. ч. пандемический H1N1, птичьего гриппа, бокавирусы, метапневмовирусы и др.). Ассоциация вирусов и бактерий утяжеляет течение болезни. Рассмотрены подходы к диагностике и терапии бронхита и внебольничной пневмонии. Лечебные мероприятия больным с острым бронхитом включают раннее начало терапии. Антибактериальная терапия острого бронхита назначается при доказанном бактериальном генезе заболевания, гипертермии более 3 дней, выраженных симптомах интоксикации и др. Общепринятым методом этиологической расшифровки пневмонии является микробиологическое исследование мокроты, а также исследование крови на предмет бактериемии. Промежуточное место занимает метод бактериоскопии; окраска мокроты по Граму позволяет врачу ориентироваться в выборе эмпирической антибактериальной терапии. В последние годы используются метод полимеразной цепной реакции и исследование пневмококкового антигена в моче; иммунохроматографически определяется полисахарид С пневмококка. Критерием качества оказания помощи пациентам с пневмонией является начало стартовой терапии антибактериальными препаратами. Результаты. В статье оценена клиническая эффективность лечения, включающего прием амоксициллина, результаты позволяют рекомендовать амоксициллин к использованию в амбулаторной практике. Background. The most common forms of lower respiratory tract infections in a doctor's practice are acute bronchitis and community-acquired pneumonia. The doctor has to decide on the management tactics of such patients, taking into account the clinical picture and examination results. Community-acquired pneumonia is a common and potentially life-threatening respiratory disease. The severity of the problem is that during periods of influenza epidemics or other respiratory viral infections Streptococcus pneumoniae is also activated, which leads to an increase in the incidence of community-acquired pneumonia. In recent years, the etiology of pneumonia has expanded significantly, and among the causes of community-acquired pneumonia, in addition to bacteria, pneumotropic viruses (new coronavirus SARS-CoV-2, MERS, influenza A viruses, including pandemic H1N1, avian influenza, bocaviruses) began to occupy an important place, metapneumoviruses, etc.). The association of viruses and bacteria aggravates the course of the disease. Approaches to the diagnosis and treatment of bronchitis and community-acquired pneumonia are considered. Therapeutic measures for patients with acute bronchitis include early initiation of therapy. Antibacterial therapy for acute bronchitis is prescribed for proven bacterial origin of the disease, hyperthermia for more than 3 days, severe symptoms of intoxication, etc. The generally accepted method of etiological deciphering of pneumonia is a microbiological examination of sputum, as well as a blood test for bacteremia. The bacterioscopy method occupies an intermediate place; Gram staining of sputum allows the doctor to guide the choice of empirical antibacterial therapy. In recent years, the polymerase chain reaction method and the study of pneumococcal antigen in urine have been used; Polysaccharide C of pneumococcus is determined immunochromatographically. The criterion for the quality of care for patients with pneumonia is the initiation of initial therapy with antibacterial drugs. Results. The article evaluates the clinical effectiveness of treatment including amoxicillin was assessed; the results allow us to recommend amoxicillin for use in outpatient practice.

Study protocol: infectious diseases consortium (I3D) for study on integrated and innovative approaches for management of respiratory infections: respiratory infections research and outcome study (RESPIRO)

BackgroundCommunity-acquired respiratory infections are a leading cause of illness and death globally. The aetiologies of community-acquired pneumonia remain poorly defined. The RESPIRO study is an ongoing prospective observational cohort study aimed at developing pragmatic logistical and analytic platforms to accurately identify the causes of moderate-to-severe community-acquired pneumonia in adults and understand the factors influencing disease caused by individual pathogens. The study is currently underway in Singapore and has plans for expansion into the broader region.MethodsRESPIRO is being conducted at three major tertiary hospitals in Singapore. Adults hospitalised with acute community-acquired pneumonia or lower respiratory tract infections, based on established clinical, laboratory and radiological criteria, will be recruited. Over the course of the illness, clinical data and biological samples will be collected longitudinally and stored in a biorepository for future analysis.DiscussionThe RESPIRO study is designed to be hypothesis generating, complementary to and easily integrated with other research projects and clinical trials. The detailed clinical database and biorepository will yield insights into the epidemiology and outcomes of community-acquired lower respiratory tract infections in Singapore and the surrounding region and offers the opportunity to deeply characterise the microbiology and immunopathology of community-acquired pneumonia.

2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia.

New evidence is available examining the use of corticosteroids in sepsis, acute respiratory distress syndrome (ARDS) and community-acquired pneumonia (CAP), warranting a focused update of the 2017 guideline on critical illness-related corticosteroid insufficiency. To develop evidence-based recommendations for use of corticosteroids in hospitalized adults and children with sepsis, ARDS, and CAP. The 22-member panel included diverse representation from medicine, including adult and pediatric intensivists, pulmonologists, endocrinologists, nurses, pharmacists, and clinician-methodologists with expertise in developing evidence-based Clinical Practice Guidelines. We followed Society of Critical Care Medicine conflict of interest policies in all phases of the guideline development, including task force selection and voting. After development of five focused Population, Intervention, Control, and Outcomes (PICO) questions, we conducted systematic reviews to identify the best available evidence addressing each question. We evaluated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach and formulated recommendations using the evidence-to-decision framework. In response to the five PICOs, the panel issued four recommendations addressing the use of corticosteroids in patients with sepsis, ARDS, and CAP. These included a conditional recommendation to administer corticosteroids for patients with septic shock and critically ill patients with ARDS and a strong recommendation for use in hospitalized patients with severe CAP. The panel also recommended against high dose/short duration administration of corticosteroids for septic shock. In response to the final PICO regarding type of corticosteroid molecule in ARDS, the panel was unable to provide specific recommendations addressing corticosteroid molecule, dose, and duration of therapy, based on currently available evidence. The panel provided updated recommendations based on current evidence to inform clinicians, patients, and other stakeholders on the use of corticosteroids for sepsis, ARDS, and CAP.

Design, Characterization, and Bioanalytical Applications of Green Terbium- and Nitrogen-Doped Carbon Quantum Dots as a Fluorescent Nanoprobe for Omadacycline Analysis.

Terbium- and nitrogen-doped carbon quantum dots (Tb,N@CQDs) were greenly created employing microwave synthesis from plum juice with terbium nitrate. The synthesis of Tb,N@CQDs was fast (7 min) with a high quantum yield (35.44%). Tb,N@CQDs were fully characterized using transmission electron microscopy, Zeta potential analysis, fluorescence, and ultraviolet spectroscopy. Omadacycline (OMC) is a broad-spectrum tetracycline that has been recently approved by the United States Food and Drug Act (FDA) in October 2018. OMC is the first oral aminomethylcycline class antibiotic drug that was authorized for the treatment of acute skin structure infections and community-acquired pneumonia. Tb,N@CQDs exhibited emission at 440 nm after excitation at 360 nm, where their fluorescence intensity showed a reduction upon addition of OMC. The experimental parameters were further studied and optimized. The linear range was between 40 and 60 parts per billion (ppb), with (limit of quantitation) equal to 34.78 ppb. The proposed approach was validated for bioanalytical purposes using FDA guidelines and proved to be straightforward, cheap, highly sensitive, and very selective, which can be used in clinical studies. The developed approach proved to be green using some current assessment metrics and was applied successfully for the determination of OMC in human plasma, milk, and pharmaceutical formulations as well as pharmacokinetic study.

Clinical characteristics for distinguishing between acute cardiogenic pulmonary edema and community-acquired pneumonia in elderly patients: a prospective observational study.

Heart failure and pneumonia are highly prevalent in elderly patients. We conducted a study to evaluate the differences in the patterns of symptoms, laboratory findings, and computed tomography (CT) results in elderly patients with acute cardiogenic pulmonary edema (ACPE) and community-acquired pneumonia (CAP). From January 1, 2015 to December 31, 2017, we studied 140 patients aged >75 years who were diagnosed with ACPE and CAP. Symptoms, laboratory findings, mean ostial pulmonary vein (PV) diameter and patterns on CT images were assessed. The primary measures of diagnostic accuracy were assessed using the positive likelihood ratio (LR+). The cutoff value of ostial PVs for differentiating patients with ACPE from CAP was evaluated using the receiver operating characteristic (ROC) analysis. Ninety-three patients with ACPE, 36 with CAP, and 11 with complicated ACPE/CAP were included. In patients with ACPE, edema (LR+ 5.4) was a moderate factor for rule-in, and a high brain natriuretic peptide level (LR+ 4.2) was weak. In patients with CAP, cough (LR+ 5.7) and leukocytosis (LR+ 5.2) were moderate factors for rule-in, while fever (LR+ 3.8) and a high C-reactive protein level (LR+ 4.8) were weak factors. The mean diameter of ostial PVs in patients with ACPE was significantly larger than that of patients with CAP (15.8± 1.8 mm vs 9.6±1.5 mm, p< 0.01). ROC analysis revealed that an ostial PV diameter cutoff of 12.5 mm was strong evidence for distinguishing ACPE from CAP with an area under the ROC curve of 0.99 and LR+ 36.0. In conclusion, as ACPE and CAP have similar symptoms and laboratory findings, dilated ostial PVs were useful in characterizing CT images to distinguish ACPE from CAP.

Antibiotic Use for Common Infections in Pediatric Emergency Departments: A Narrative Review.

Antibiotics are one of the most prescribed medications in pediatric emergency departments. Antimicrobial stewardship programs assist in the reduction of antibiotic use in pediatric patients. However, the establishment of antimicrobial stewardship programs in pediatric EDs remains challenging. Recent studies provide evidence that common infectious diseases treated in the pediatric ED, including acute otitis media, tonsillitis, community-acquired pneumonia, preseptal cellulitis, and urinary-tract infections, can be treated with shorter antibiotic courses. Moreover, there is still controversy regarding the actual need for antibiotic treatment and the optimal dosing scheme for each infection.

A Novel Design Eco-friendly Microwave-assisted Cu–N@CQDs Sensor for the Quantification of Eravacycline via Spectrofluorimetric Method; Application to Greenness Assessments, Dosage Form and Biological Samples

Community-acquired pneumonia is one of the most common infectious diseases and a substantial cause of mortality and morbidity worldwide. Therefore eravacycline (ERV) was approved by the FDA in 2018 for the treatment of acute bacterial skin infections, GIT infections, and community-acquired bacterial pneumonia caused by susceptible bacteria. Hence, a green highly sensitive, cost-effective, fast, and selective fluorimetric approach was developed for the estimation of ERV in milk, dosage form, content uniformity, and human plasma. The selective method is based on the utilization of plum juice and copper sulphate for the synthesis of green copper and nitrogen carbon dots (Cu–N@CDs) with high quantum yield. The quantum dots' fluorescence was enhanced after the addition of ERV. The calibration range was found to be in the range 1.0 – 80.0 ng mL−1 with LOQ equal to 0.14 ng mL−1 and LOD was found to be 0.05 ng mL−1. The creative method is simple to deploy in clinical labs and therapeutic drug health monitoring system. The current approach has been bioanalytically validated using US-FDA and validated ICH criteria. High-resolution transmission electron microscopy (HR-TEM), X-ray photon spectroscopy (XPS), Zeta potential measurements, fluorescence, UV–VIS, and FTIR spectroscopy have all been used to fully characterize the Cu–N@CQDs. The Cu–N@CQDs were effectively applied in human plasma and milk samples with a high percentage of recovery ranging from 97.00 to 98.80%.

Features of the clinical course of severe community-acquired pneumonia caused by Klebsiella pneumoniae in patients with acute leukemia

Aim: To compare the course of severe community-acquired pneumonia caused by Kl. pneumonia in patients with acute lymphoblastic and myeloblastic leukaemia.Materials and methods. The study was designed as a retrospective, single-centre, controlled and non-randomized study and included 40 patients. They were divided into two groups: patients with acute myeloblastic leukaemia (22), mortality of 59% (13 patients) and patients with acute lymphoblastic leukaemia (18), mortality of 38% (7 patients).Results and discussion. The combination of acute myeloblastic leukaemia and severe community-acquired pneumonia caused by Kl. pneumonia showed a higher mortality rate, a longer duration of respiratory support, as well as a greater frequency of involvement of organs and systems in the infectious process than in acute lymphoblastic leukaemia.Conclusions: The development of pneumonia caused by Kl. pneumonia in patients with acute myeloblastic leukaemia is characterized by a more severe course. SOFA, APACHE-II, and PSI/PORT scales have limited predictive ability in patients with acute leukaemia and severe community-acquired pneumonia caused by Kl. Pneumoniae.

Vitamin D as an adjunct to antibiotics for the treatment of acute childhood pneumonia.

Children with acute pneumonia may be vitamin D deficient. Clinical trials have found that prophylactic vitamin D supplementation decreases children's risk of developing pneumonia. Data on the therapeutic effects of vitamin D in acute childhood pneumonia are limited. This is an update of a Cochrane Review first published in 2018. To evaluate the efficacy and safety of vitamin D supplementation as an adjunct to antibiotics for the treatment of acute childhood pneumonia. We searched CENTRAL, MEDLINE, Embase, and two trial registries on 28 December 2021. We applied no language restrictions. We included randomised controlled trials (RCTs) that compared vitamin D supplementation with placebo in children (aged one month to five years) hospitalised with acute community-acquired pneumonia, as defined by the World Health Organization (WHO) acute respiratory infection guidelines. For this update, we reappraised eligible trials according to research integrity criteria, excluding RCTs published from April 2018 that were not prospectively registered in a trials registry according to WHO or Clinical Trials Registry - India (CTRI) guidelines (it was not mandatory to register clinical trials in India before April 2018). Two review authors independently assessed trials for inclusion and extracted data. For dichotomous data, we extracted the number of participants experiencing the outcome and the total number of participants in each treatment group. For continuous data, we used the arithmetic mean and standard deviation (SD) for each treatment group together with number of participants in each group. We used standard methodological procedures expected by Cochrane. In this update, we included three new trials involving 468 children, bringing the total number of trials to seven, with 1601 children (631 with pneumonia and 970 with severe or very severe pneumonia). We categorised three previously included studies and three new studies as 'awaiting classification' based on the research integrity screen. Five trials used a single bolus dose of vitamin D (300,000 IU in one trial and 100,000 IU in four trials) at the onset of illness or within 24 hours of hospital admission; one used a daily dose of oral vitamin D (1000 IU for children aged up to one year and 2000 IU for children aged over one year) for five days; and one used variable doses (on day 1, 20,000 IU in children younger than six months, 50,000 IU in children aged six to 12 months, and 100,000 IU in children aged 13 to 59 months; followed by 10,000 IU/day for four days or until discharge). Three trials performed microbiological diagnosis of pneumonia, radiological diagnosis of pneumonia, or both. Vitamin D probably has little or no effect on the time to resolution of acute illness (mean difference (MD) -1.28 hours, 95% confidence interval (CI) -5.47 to 2.91; 5 trials, 1188 children; moderate-certainty evidence). We do not know if vitamin D has an effect on the duration of hospitalisation (MD 4.96 hours, 95% CI -8.28 to 18.21; 5 trials, 1023 children; very low-certainty evidence). We do not know if vitamin D has an effect on mortality rate (risk ratio (RR) 0.69, 95% CI 0.44 to 1.07; 3 trials, 584 children; low-certainty evidence). The trials reported no major adverse events. According to GRADE criteria, the evidence was of very low-to-moderate certainty for all outcomes, owing to serious trial limitations, inconsistency, indirectness, and imprecision. Three trials received funding: one from the New Zealand Aid Corporation, one from an institutional grant, and one from multigovernment organisations (Bangladesh, Sweden, and UK). The remaining four trials were unfunded. Based on the available evidence, we are uncertain whether vitamin D supplementation has important effects on outcomes of acute pneumonia when used as an adjunct to antibiotics. The trials reported no major adverse events. Uncertainty in the evidence is due to imprecision, risk of bias, inconsistency, and indirectness.

Regional Experience in Improving the Quality and Cost-Effectiveness of Medical Care for Children with Acute Respiratory Pathology in the Rostov Region

One of the priorities of the modern world medical community is the continuous comprehensive improvement of medical care quality. Evaluation of medical care quality and material costs level for the management of patients with acute respiratory pathology (ARP) was performed in one city medical facility, as well as cost-effectiveness analysis of the project “Improvement of medical care quality for children of the Rostov region”. The first step of this study was retrospective audit of source medical records (n = 154) of Children’s hospital via the adapted World Health Organization questionnaire “Evaluation of in-patient care quality for children” recommended for Europe and revised in 2015. Inclusion criteria: hospitalization of patients with acute conditions; outcome — recovery with no complications; presence of one of the clinical manifestations (acute nasopharyngitis, acute non-obstructive bronchitis, acute obstructive bronchitis, acute obstructive laryngitis, acute community-acquired pneumonia). The cost-effectiveness evaluation was performed considering the direct treatment costs and the coefficient of economic costs per patient (CECPP). Analysis of the study’s first stage has revealed defects in medical care quality, significant and irrational material costs of the medical facility at all stages of medical and diagnostic care for children with ARP. CECPP peak indicators came under notice in all observation groups due to high expenses on medications and specifically those not included in clinical practice guidelines, vast amount of unreasonable hospitalizations and diagnostic procedures, expenses on physical therapy (PT), etc. Analysis of the study’s second stage medical records (n = 146) of patients with ARP took place after the initial audit followed by quarterly monitoring and hospital staff training (endpoint — 12 months). Significant improvements in the health care quality and cost-effectiveness for children with ARP have been shown.

Decreased capsaicin cough reflex sensitivity predicts hospitalisation due to COPD

IntroductionPatients with chronic obstructive pulmonary disease (COPD) are often hospitalised due to severe acute exacerbation (AE) or community-acquired pneumonia (CAP). Previous studies revealed the association of cough reflex sensitivity with...

Characterization of the Microbiome and Host's Metabolites of the Lower Respiratory Tract During Acute Community-Acquired Pneumonia Identifies Potential Novel Markers.

Community-acquired pneumonia (CAP) is one of the most frequently encountered infectious diseases worldwide. Few studies have explored the microbial composition of the lower respiratory tract (LRT) and host metabolites of CAP. We analyzed the microbial composition of the LRT and levels of host metabolites to explore new biomarkers for CAP. Bronchoalveolar lavage fluid (BALF) was collected from 28 CAP patients and 20 healthy individuals. Following centrifugation, BALF pellets were used for amplicon sequencing of a variable region of the bacterial 16S rDNA gene to characterize the microbial composition. Non-targeted metabolomics was used to detect host's metabolites in the supernatant. Compared with healthy individuals, the bacterial alpha diversity in the LRT of CAP patients was significantly lower in CAP patients (p<0.05). On the bacterial genus level, over 20 genera were detected with lower relative abundance (p<0.05), while the relative abundance of Ruminiclostridium-6 was significantly higher in CAP patients. The levels of the host metabolites dimethyldisulfide, choline, pyrimidine, oleic acid and N-acetyl-neuraminic acid were all increased in BALF of CAP patients (p<0.05), while concentrations of lysophosphatidylcholines (LPC (12:0/0:0)) and phosphatidic acid (PA (20:4/2:0)) were decreased (p<0.05). Furthermore, the relative abundance of Parvimonas, Treponema-2, Moraxella, Aggregatibacter, Filifactor, Fusobacterium, Lautropia and Neisseria negatively correlated with concentrations of oleic acid (p<0.05). A negative correlation between the relative abundance of Treponema-2, Moraxella, Filifactor, Fusobacterium and dimethyldisulfide concentrations was also observed (p<0.05). In contrast, the relative abundance of Treponema-2, Moraxella, Filifactor, and Fusobacterium was found to be positively associated with concentrations of LPC (12:0/0:0) and PA (20:4/2:0) (p<0.05). The composition of the LRT microbiome differed between healthy individuals and CAP patients. We propose that some respiratory microbial components and host metabolites are potentially novel diagnostic markers of CAP.

Aetiology of childhood pneumonia in low- and middle-income countries in the era of vaccination: a systematic review.

BackgroundThis systematic review aimed to describe common aetiologies of severe and non-severe community acquired pneumonia among children aged 1 month to 9 years in low- and middle-income countries.MethodsWe searched the MEDLINE, EMBASE, and PubMed online databases for studies published from January 2010 to August 30, 2020. We included studies on acute community-acquired pneumonia or acute lower respiratory tract infection with ≥1 year of continuous data collection; clear consistent case definition for pneumonia; >1 specimen type (except empyema studies where only pleural fluid was required); testing for >1 pathogen including both viruses and bacteria. Two researchers reviewed the studies independently. Results were presented as a narrative summary. Quality of evidence was assessed with the Quality Assessment Tool for Quantitative Studies. The study was registered on PROSPERO [CRD42020206830].ResultsWe screened 5184 records; 1305 duplicates were removed. The remaining 3879 titles and abstracts were screened. Of these, 557 articles were identified for full-text review, and 55 met the inclusion criteria – 10 case-control studies, three post-mortem studies, 11 surveillance studies, eight cohort studies, five cross-sectional studies, 12 studies with another design and six studies that included patients with pleural effusions or empyema. Studies which described disease by severity showed higher bacterial detection (Streptococcus pneumoniae, Staphylococcus aureus) in severe vs non-severe cases. The most common virus causing severe disease was respiratory syncytial virus (RSV). Pathogens varied by age, with RSV and adenovirus more common in younger children. Influenza and atypical bacteria were more common in children 5-14 years than younger children. Malnourished and HIV-infected children had higher rates of pneumonia due to bacteria or tuberculosis.ConclusionsSeveral viral and bacterial pathogens were identified as important targets for prevention and treatment. Bacterial pathogens remain an important cause of moderate to severe disease, particularly in children with comorbidities despite widespread PCV and Hib vaccination.

The traditional Chinese patented medicine Qingke Pingchuan granules alleviate acute lung injury by regenerating club cells

Qingke Pingchuan granules (QKPCG), a patented traditional Chinese medicine, clinically, are recommended for acute tracheobronchitis, cough, community‐acquired pneumonia, and other respiratory diseases. However, its potential protective effect and mechanism of action in acute lung injury (ALI) have not been explored. We aimed to explore the mechanisms underlying the protective role of QKPCG in ALI. The therapeutic efficacy of QKPCG was investigated in a lipopolysaccharide (LPS)‐induced ALI mouse model. Mice were divided into three groups, namely, the Control, LPS, and LPS + QKPCG groups. Mice in the LPS + QKPCG group were administered QKPCG intragastrically as a treatment once a day for a total of three days. QKPCG effectively increased survival and reduced lung injury in treated mice. It significantly reduced the LPS‐induced expression of interleukin (IL)‐6, tumor necrosis factor‐α (TNF‐α), IL‐1α, and IL‐1β. RNA‐sequencing followed by real‐time quantitative polymerase chain reaction validation suggested a critical role of the secretoglobin family 1A member 1 (Scgb1a1) gene in mediating the protective effect of QKPCG. Further, QKPCG reversed the LPS‐induced downregulation of the Clara cell 10 kDa protein (CC10), a pulmonary surfactant protein encoded by Scgb1a1, which is mainly secreted by club cells in the lungs. Exogenous supplementation of CC10 alleviated LPS‐induced ALI. Hematoxylin and eosin staining and enzyme‐linked immunosorbent assay results further confirmed the anti‐inflammatory properties of CC10, which were suggested as mediated via the inhibition of NFκB phosphorylation. In summary, our study provides evidence of the beneficial role of QKPCG in alleviating lung injury, mediated via the decreased disruption of club cells and higher expression of CC10, which leads to NFκB pathway inhibition.

A limited role for microbiological testing for childhood lower respiratory tract infections in primary care: managing diagnostic uncertainty by withholding antibiotics and watchful waiting

Lower respiratory tract infection (LRTI) is defined as an infection that affects the airways below the level of the larynx. In children, LRTI is frequently used to include acute bronchitis, bronchiolitis, and community-acquired pneumonia (CAP). The WHO estimates that LRTI is the most common infectious cause of death worldwide and the fourth most common cause overall, with 2.6 million deaths attributed to LRTI in 2019 [1].

Specficics of the pro-antioxidant and antioxidant status in children with acute pneumonia, depending on the severity of the pathological process and the etiological factor

Background: In the recent years, an increasing number of researchers, in addition to the standard causes of a particular pathologys development, have been paying attention to changes in the immune, pro-antioxidant, psychosomatic and other systemic factors. The processes occurring in the body with the participation of reactive oxygen species are general biological mechanisms of tissue damage and protection. Their role has been described and proven in a variety of nosologies. However, the number of studies evaluating the interaction of prooxidants with antioxidants in children with acute pneumonia is quite few.&#x0D; Aims: Analysis of the pro-/antioxidant status in children with acute pneumonia, depending on the severity of the pathological process and the etiological factor.&#x0D; Methods: The main group consisted of 50 patients with acute pneumonia, who were divided into 2 subgroups according to the severity of the disease course. The comparison group consisted of 30 conditionally healthy children. In addition to the list of examinations of children with acute pneumonia, according to the clinical practice guidelines, Imax, S, t values were assessed in the study groups by the method of luminol-dependent chemiluminescence (CL) of the blood plasma, depending on the severity of the pathological process and the etiological factor.&#x0D; Results: After conducting a ROC analysis in children in the acute period of pneumonia, we established the threshold values of the pro-/antioxidant status parameters: at the Imax level 28.1%; S 26.2%; t 0.34 min. the examined children had a more severe course of pneumonia. When Mycoplasma pneumoniae, Chlamydophila pneumoniae were detected in the sputum, the level of the pro-/antioxidant status parameters was lower (Imax=28.0%, S=36.0%, t=0.37 min) than that in children who had Gram-negative bacteria or Gram-positive bacteria in the sputum (Imax=46.0%, S=45.0; t=0.42 min); p 0.05.&#x0D; Conclusion: Violations of the pro-/antioxidant status were noted in all the children we examined. The most pronounced violations of the pro-/antioxidant status were detected in children with acute community-acquired severe pneumonia caused by atypical pathogens M. pneumoniae, C. pneumoniae. In addition, the ROC analysis made it possible to determine the threshold values of the pro-/antioxidant status parameters for assessing the severity of pneumonia in children during the acute period of the disease.

Variety of effects of silicon dioxide colloid in the treatment of antibiotic-associated diarrhea in children

Antibiotic-associated diarrhea (AAD) is a key aspect of pediatrics concerning antibiotic therapy Purpose. The article aims at investigating the effects of colloidal silicon dioxide in the treatment of antibiotic-associated diarrhea in children. Materials and methods. Using parametric and nonparametric methods of analysis, 83 patients were examined (treatment group — 41 children who used colloidal silicon dioxide and the control group — 42 children) of both sexes (mean age (13.7 ± 2.6) years) with pathology of the lower respiratory tract (acute bronchitis or community-acquired pneumonia), who developed AAD against the background of ABT. Results. When using colloidal silicon dioxide in 75.6% of children, diarrhea decreased by the 2nd day and stopped by the 4th day (median — 0 points). Against the background of taking the drug throughout the treatment, there was a marked 3-fold decrease in all AAD values. The assessment of the efficacy and safety of the drug according to the data of medical researchers was 3.4 points. Analysis of subjective data on the tolerability of the drug showed «excellent» and «good». Against the background of the full course of treatment with colloidal silicon dioxide, a 2 times more pronounced decrease in the characteristics of AAD was noted. Conclusion. The presented data are intended to focus the attention of pediatricians on the rational use of ABT, timely diagnosis of an unwanted drug reaction in the form of AAD and its correction. The studied drug showed high efficacy and safety, which makes it possible to recommend it as a symptomatic treatment of diarrhea that developed against the background of ABT treatment in the complex therapy of diseases of the lower respiratory tract in children.