Severe Community-acquired Pneumonia In Children Research Articles

Adenovirus and Mycoplasma pneumoniae co-infection as a risk factor for severe community-acquired pneumonia in children.

To investigate the pathogenic characteristics and risk factors of pediatric severe community-acquired pneumonia (CAP). We retrospectively analyzed the clinical data of hospitalized children with severe CAP from April 2014 to June 2019 in China. Data of age, sex and pathogenic results were collected: bacterial and fungal cultures, respiratory viruses from sputum or bronchoalveolar lavage fluid (BALF), serum Mycoplasma pneumoniae (MP)-IgM and Chlamydia Pneumoniae-IgM, and BALF or blood (1-3)-β-D-glucan/galactomannan test. A total of 679 children with severe CAP were included in the analysis. The number of cases infected with MP was higher in males than in females. There were significant differences between the ≤1-year and >1-year groups in terms of pathogen. The top three bacteria cultured were Haemophilus influenzae (57/679, 8.4%), Streptococcus pneumoniae (50/679, 7.4%), and Pseudomonas aeruginosa (25/679, 3.7%). The top three viruses detected were adenovirus (AdV, 124/679, 18.3%), respiratory syncytial virus (24/679, 3.5%), and parainfluenza virus (21/679, 3.1%). AdV and MP were the leading pathogens, detected in 18.3% and 32.6% cases, respectively. MP infection increased the risk of AdV infection (OR 3.77, p < 0.0001). MP infection was a risk factor for severe AdV-infected pneumonia, while sex, age, bacteria, Chlamydia Pneumoniae, fungal, and AdV infections were risk factors for severe MP-infected pneumonia. AdV and MP were dominant pathogens in children with severe CAP. AdV and MP infection predisposed each other to develop severe illness. AdV-MP co-infection may lead to severe pneumonia.

Клинико-лабораторные предикторы тяжелой внебольничной пневмонии у детей до четырех лет

Community-acquired pneumonia (CAP) is a major cause of pediatric morbidity and mortality. Currently, there is no common approach to determination of CAP severity in children, which hampers early diagnosis and treatment of the disease. The study was aimed to determine clinical and laboratory predictors of severe CAP in children under 4 years of age. Analysis of clinical data, parameters of complete blood count (CBC), C-reactive protein (CRP) using nonparametric methods for hypothesis testing, univariate correlation analysis, cross-tabulation (Statistica 10.0), logistic regression, and ROC analysis (SPSS Statistics 20.0) was performed in 72 children aged 1 month to 3 years 11 months admitted to hospital due to CAP. Severe CAP was diagnosed in 16.7% of children. Causes of severe CAP included respiratory distress (moderate — 58.3%, severe — 16.7% of cases) and sepsis (25%). We identified significant clinical predictors of severe CAP: vomiting (OR 4.2), tachypnea (OR 28.3), chest wall retractions (OR 6), wheezing (OR 4), and the absence of rhinitis (OR 0.21). Isolated assessment of the CBC and CRP did not allow to predict CAP severity. We have developed a prediction model predicting severe CAP in children under 4 years of age based on the presence of rhinitis, tachypnea, as well as leukocyte count (sensitivity and specificity 91.7%). Thus, currently the main cause of severe CAP in children under 4 years of age is respiratory distress, in which wheezing predominates. Physical examination with an emphasis on detection of rhinitis and respiratory distress is essential for diagnosing severe CAP. The use of a pneumonia severity prediction model may contribute to improvement of management of CAP in patients under 4 years of age.

Clinical features and risk factors analysis for poor outcomes of severe community-acquired pneumonia in children: a nomogram prediction model.

Pneumonia remains the leading cause of death among children aged 1-59 months. The early prediction of poor outcomes (PO) is of critical concern. This study aimed to explore the risk factors relating to PO in severe community-acquired pneumonia (SCAP) and build a PO-predictive nomogram model for children with SCAP. We retrospectively identified 300 Chinese pediatric patients diagnosed with SCAP who were hospitalized in the Affiliated Hospital of Southwest Medical University from August 1, 2018, to October 31, 2021. Children were divided into the PO and the non-PO groups. The occurrence of PO was designated as the dependent variable. Univariate and multivariate logistic regression analyses were used to identify the risk factors of PO. A nomogram model was constructed from the multivariate logistic regression analysis and internally validated for model discrimination and calibration. The performance of the nomogram was estimated using the concordance index (C-index). According to the efficacy evaluation criteria, 56 of 300 children demonstrated PO. The multivariate logistic regression analysis resulted in the following independent risk factors for PO: co-morbidity (OR: 8.032, 95% CI: 3.556-18.140, P < 0.0001), requiring invasive mechanical ventilation (IMV) (OR: 7.081, 95% CI: 2.250-22.282, P = 0.001), and ALB < 35 g/L (OR: 3.203, 95% CI: 1.151-8.912, P = 0.026). Results of the internal validation confirmed that the model provided good discrimination (concordance index [C-index], 0.876 [95% CI: 0.828-0.925]). The calibration plots in the nomogram model were of high quality. The nomogram facilitated accurate prediction of PO in children diagnosed with SCAP and could be helpful for clinical decision-making.

Pathogenic Role and Antibiotic Resistance of Methicillin-Resistant Staphylococcus aureus (MRSA) Strains Causing Severe Community-Acquired Pneumonia in Vietnamese Children.

In recent years, the pathogenic role and antibiotic resistance of methicillin-resistant Staphylococcus aureus (MRSA) strains causing severe community-acquired pneumonia (CAP) have received increasing attention in clinical practice. The aim of this study was to determine the rate of isolates of MRSA strains causing severe CAP in children and to assess their level of antibiotic resistance. The study design was cross-sectional. Children with severe CAP were sampled by nasopharyngeal aspiration for the culture, isolation, and identification of MRSA. Antimicrobial susceptibility testing was performed using the gradient diffusion method to determine the minimum inhibitory concentration (MIC) of antibiotics. Results: MRSA was identified as the second leading cause of severe CAP in Vietnamese children. The rate of isolates of S. aureus was 41/239 (17.5%), of which most were MRSA, at 32/41 (78.0%). MRSA strains were completely non-susceptible to penicillin (100%), more resistant to clindamycin and erythromycin, less sensitive to ciprofloxacin and levofloxacin, and fully susceptible to vancomycin and linezolid, with a 32-fold decreased MIC90 for vancomycin (0.5 mg/L) and a 2-fold decreased MIC90 for linezolid (4 mg/L). Therefore, vancomycin and linezolid may be appropriate options for severe CAP identified by MRSA.

Clinical Evaluation of Metagenomic Next-Generation Sequencing for the detection of pathogens in BALF in severe community acquired pneumonia

BackgroundRapid and accurate identification of pathogens is very important for the treatment of Severe community-acquired pneumonia (SCAP) in children. Metagenomic Next-generation sequencing (mNGS) has been applied in the detection of pathogenic bacteria in recent years, while the overall evaluation the application of SCAP in children is lacking.MethodsIn our study, 84 cases of SCAP were enrolled. Bronchoalveolar lavage fluid (BALF) samples were analysed using mNGS; and sputum, blood, and BALF samples were analysed using conventional technology (CT).ResultsAmong the 84 children, 41 were boys, and 43 were girls, with an average age ranging from 2 months to 14 years. The pathogen detection rate of mNGS was higher than that of CT (83.3% [70/84] vs. 63.1% [53/84], P = 0.003). The mNGS was much greater than that of the CT in detecting Streptococcus pneumoniae (89.2% [25/29] vs. 44.8% [13/29], P = 0.001) and Haemophilus influenzae (91.7% [11/12] vs. 33.3% [4/12], P < 0.005). The mNGS also showed superior fungal detection performance compared with that of the CT (81.8% [9/11] vs. 18.2% [2/11], P = 0.004). The mNGS test can detect viruses, such as bocavirus, rhinovirus, and human metapneumovirus, which are not frequently recognised using CT. However, the mNGS detection rate was lower than that of the CT (52.4% [11/21] vs. 95.2% [20/21], P = 0.004) for Mycoplasma pneumoniae (MP). The detection rate of mNGS for mixed infection was greater than that of the CT, although statistical significance was not observed (26.3% [20/39] vs. 21.1% [16/39], P > 0.005). Treatment for 26 (31.0%) children was changed based on mNGS results, and their symptoms were reduced; nine patients had their antibiotic modified, five had antibiotics added, nine had their antifungal medication, and seven had their antiviral medication.ConclusionmNGS has unique advantages in the detection of SCAP pathogens in children, especially S. pneumoniae, H. influenzae, and fungi. However, the detection rate of MP using mNGS was lower than that of the CT. Additionally, mNGS can detect pathogens that are not generally covered by CT, which is extremely important for the modification of the treatment strategy.

A Retrospective Study on Factors Associated with Severe Childhood Community-Acquired Pneumonia

Background and Aim: Globally, community-acquired pneumonia (CAP) is the most common source of mortality among children. Early diagnosis and effective management need the identification of risk factors. The purpose of this study was to characterize the clinical symptoms and investigation of various risk factors for severe CAP in children. Patients and Methods: A retrospective study was conducted on 186 children in the Pediatric Department of Niazi Welfare Teaching Hospital, Sargodha from March 2022 to November 2022. Children with pneumonia who had radiological confirmation were included. Community-acquired pneumonia cases were categorized into two groups: Group-I composed of severe CAP cases whereas Group-II non-severe CAP cases. Baseline characteristics such as age, nutritional status, and gender were collected. Vital signs, fever, duration of symptoms, and physical findings such as chest retraction, cyanosis, wheezing, and nasal faring were clinical data recorded. Laboratory findings such as serum electrolyte, full blood count, and inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were recorded. SPSS version 27 was used for data analysis. Results: Of the total 186 children, there were 74 (39.8%) females and 112 (60.2%) male. Age-wise distribution of patients were as follows: 146 (78.5%) in 0-5 years, 26 (14%) in 6-10 years, and 14 (7.5%) in 11-15 years. Out of 186 children, the incidence of severe and non-severe CAP was 58 (31.2%) and 130 (68.8%) respectively. The most common clinical signs in both categories are fever and cough, followed by reduced appetite, vomiting, and shortness of breath. A seizure is present in 14 (24.1%) severe CAP cases. Based on physical examination, Rhonchi is found in 94 (72.3%) non-severe and 46 (79.3%) severe CAP patients. Among patients with severe pneumonia, over half have chest retractions, but only 22% have non-severe pneumonia. Tachypnea was experienced by approximately 33% of severe pneumonia patients against 14% of individuals with non-severe pneumonia. As inflammatory indicators, ESR and CRP are high in all groups. Conclusion: The present study concluded that a fever persisting for &gt;7 days and an elevation in RR are risk factors for severe pneumonia. Severe pneumonia is also prevented by a normal hematocrit level and BMI. There was a higher rate of severe pneumonia in CAP hospitalizations in children who had fevers lasting longer than seven days as well as tachypnea. According to these findings, RR should be utilized to determine both the severity of pneumonia and the identification of pneumonia. Keywords: Sever community-acquired pneumonia, Risk factors, Childhood pneumonia

Real-world Biapenem vs. Meropenem in the treatment of severe community-acquired pneumonia in children: A propensity score matching analysis.

To compare the real-world efficacy and safety of Biapenem and Meropenem for treating severe community-acquired pneumonia (SCAP) in children. We retrospectively evaluated 915 children with SCAP who were treated with Biapenem or Meropenem from August 2018 to June 2022. A 1:1 propensity score matching (PSM) analysis was used to reduce the actual baseline difference between groups. 416 patients participated in the analysis after PSM (Biapenem: Meropenem = 1:1). For the Biapenem group and Meropenem group, the effective rates were 90.4% and 90.9%, respectively (p = 1.0) and the incidence of adverse reactions were 7.7% and 7.2%, respectively (p = 1.0). There were no statistical differences between Biapenem and Meropenem. In general, the efficacy and safety of Biapenem are comparable to Meropenem in the treatment of children with SCAP.

Диагностика и лечение внебольничной пневмонии у детей

На практике, особенно в амбулаторных условиях, серьезными проблемами педиатрии являются ранняя диагностика и рациональная терапия пневмонии у детей. Наиболее распространенными возбудителями при внебольничной пневмонии являются Streptococcus pneumoniae, Haemophilus influenzae и другие микроорганизмы, в том числе вирусы и грибы. Следует уточнить, что этиология заболеваний нижнего респираторного тракта резко отличается в разных возрастных группах. Самой частой причиной внебольничной пневмонии (до 50 %) является S.pneumoniae, реже встречаются такие палочки, как E.сoli, Klebsiella spp., C.trachomatis, Mycoplasma, Ureаplasma. У детей старше 5 лет в этиологической структуре внебольничной пневмонии наряду с S.рneumoniae возрастает значимость Mycoplasma рneumoniae. Резистентность возбудителей инфекции к антибактериальным препаратам — нарастающая глобальная проблема. Алгоритм диагностики внебольничной пневмонии включает фебрильную температуру продолжительностью &gt; 3 дней, цианоз, одышку при отсутствии признаков бронхиальной обструкции, кашель. Тахипноэ является одним из лучших предикторов пневмонии у детей всех возрастов. При физикальном обследовании — наличие укорочения перкуторного звука в зоне поражения, бронхиальное или ослабленное дыхание, звучные мелкопузырчатые или крепитирующие хрипы. Для диагностики нетяжелых внебольничных пневмоний вполне достаточно ограничиться клиническими симптомами, рентгенографией легких, общим анализом крови. Начальная антибиотикотерапия внебольничной пневмонии проводится эмпирическим путем. При лечении нетяжелых внебольничных пневмоний у детей от 2 мес. до 5 лет препаратом выбора является амоксициллин перорально. Макролиды — препараты выбора у детей от 5 до 16 лет. При тяжелой пневмонии препаратами выбора являются амоксициллин/клавуланат, цефалоспорины II, III, IV поколения. В целом продолжительность антибиотикотерапии при внебольничной пневмонии, вызванной типичными бактериями, составляет 7–10 дней, атипичными бактериями — 10–14 дней. В реальной клинической практике при проведении антибактериальной терапии нередко наблюдаются ошибки, связанные с выбором препарата, пути введения, дозировки, режима применения, длительности курса.

Heightened Local Th17 Cell Inflammation Is Associated with Severe Community-Acquired Pneumonia in Children under the Age of 1 Year.

Severe community-acquired pneumonia (sCAP) early in life is a leading cause of morbidity, mortality, and irreversible sequelae. Herein, we report the clinical, etiological, and immunological characteristics of 62 children age < 1 year. We measured 27 cytokines in plasma and bronchoalveolar lavage (BAL) from 62 children age < 1 year who were diagnosed with CAP, and then, we analyzed correlations among disease severity, clinical parameters, and etiology. Of the entire cohort, three cytokines associated with interleukin-17- (IL-17-) producing helper T cells (Th17 cells), IL-1β, IL-6, and IL-17, were significantly elevated in sCAP patients with high fold changes (FCs); in BAL, these cytokines were intercorrelated and associated with blood neutrophil counts, Hb levels, and mixed bacterial-viral infections. BAL IL-1β (area under the curve (AUC) 0.820), BAL IL-17 (AUC 0.779), and plasma IL-6 (AUC 0.778) had remarkable predictive power for sCAP. Our findings revealed that increased local Th17 cell immunity played a critical role in the development of sCAP in children age < 1 year. Th17 cell-related cytokines could serve as local and systemic inflammatory indicators of sCAP in this age group.

The Diagnostic Value of Lung Ultrasonography in Children Community-Acquired Pneumonia

To explore the diagnostic value of lung ultrasonography in children community-acquired pneumonia is the objective of the study. A total of 126 children who were diagnosed with community-acquired pneumonia and underwent lung ultrasonography examination during the course of the disease were selected. All patients underwent lung ultrasonography and chest X-ray examination within 24 h of admission. The clinical characteristics of lung ultrasonography examination of community-acquired pneumonia were analyzed and the sensitivity, specificity, correct index and diagnostic coincidence rate of lung consolidation with lung ultrasonography and chest X-ray were compared. The lung ultrasonography imaging features of severe community-acquired pneumonia in children are the disappearance of A-line, increase of B-line, waterfall sign, lung consolidation, bronchial inflation sign, pleural effusion, etc. 53 cases of patients chest computed tomography results were used as the gold standard. The sensitivity, correct index and diagnostic coincidence rate of lung ultrasonography in the diagnosis of lung consolidation were all higher than those of X-ray diagnosis and the differences were statistically significant (p<0.05). Lung ultrasonography determined abnormal changes in the lungs of 124 children and chest X-ray determined abnormal changes in the lungs of 122 children. The chest X-rays of 2 children showed normal, while the lung ultrasonography showed a large number of B-line and lung consolidation in both lungs. A total of 17 cases of pleural effusion were determined by lung ultrasonography and 1 case of pleural effusion was determined by chest X-ray. The difference between the two groups was statistically significant (p<0.05). Lung ultrasonography in children community-acquired pneumonia is superior to chest X-ray in lung consolidation and pleural effusion and can be used for diagnosis of children community-acquired pneumonia.

Should COVID-19 take advice from rheumatologists?

Should COVID-19 take advice from rheumatologists?

Interleukin 1 receptor antagonist (IL1RA) gene polymorphism and levels associated with adverse outcome in severe community-acquired pneumonia in children: A hospital-based study in India.

High morbidity and mortality due to community-acquired pneumonia (CAP) is seen in children under 5 years of age in India. Besides identified risk factors for CAP, there may be a phenotype-genotype association with cytokines, resulting in enhanced inflammatory response resulting in the adverse outcome (AO), namely complications and death. To assess the association of IL1RA gene polymorphism on serum levels of IL1RA and with AO in children under 5 years of age hospitalized with WHO-defined severe CAP. A prospective cohort study with nested case-control design conducted in a tertiary care teaching hospital after obtaining institutional ethical approval. Included were children between 2 and 59 months of age hospitalized with WHO-defined severe CAP with consistent radiological abnormalities. Excluded were those with suspected or proven cystic fibrosis, pulmonary tuberculosis, malignancy, immunodeficiency, and congenital heart disease. Polymerase chain reaction (PCR) was used to analyze the Variable Number of Tandem Repeats (VNTRs) of IL1RA gene polymorphism and ELISA test to detect serum levels of IL1RA. From 2014 to 2016, of 420 screened cases, 350 were eligible and included, of which 132 (37.7%) had no complication and 218 (62.3%) had AO, which included complications like empyema, pyopneumothorax, acute respiratory distress syndrome (ARDS), and septic shock of these 24 (6.9%) expired. Higher risk of AO was seen in A2A2 genotype (OR 11.18, p 0.0001) and lower in A1A1 genotype (OR 0.18, P < 0.0001). Serum IL1RA (ng/mL) was statistically significantly elevated in CAP with AO (2.55 ± 1.44) versus uncomplicated (0.87 ± 0.52) (P < 0.0001). In IL1RA gene, A1A1 genotype was associated with lower risk and A2A2 genotype with increased the risk of AO. Higher serum levels of IL1RA were found in A2A2 genotype indicating possibly enhanced inflammatory response resulting in AO of CAP.

Clinical and epidemiological characteristics of severe community-acquired pneumonia in children after introduction of the 10-valent pneumococcal vaccine.

BackgroundPneumonia is an important cause of morbimortality in Brazil, despite the extensive vaccination coverage and the socioeconomic improvement in the past years.ObjectiveTo describe the epidemiological and clinical characteristics of severe community-acquired pneumonia in children after the introduction of the 10-valent pneumococcal conjugate vaccine (PCV10).MethodsA prospective study included children <5 years old hospitalized for pneumonia between October 2010 and September 2013 in a tertiary hospital. Newborns and children with comorbidities were excluded. Pneumonia classification followed the clinical and radiological criteria established by World Health Organization (WHO). Clinical history, nutritional status, immunizations, diagnosis, disease course, and prognosis were analyzed.ResultsAmong 452 children, almost 70% were <2 years, with no sex differences, and 10% had weight-for-age z score below than −2.0. Family income was up to one minimum wage in half the households, and 40% of mothers had completed high school. The suitability of both influenza and PCV10 vaccine schedules was ∼50%. The first medical care happened later than 72 hours after the onset of symptoms in 42% of cases. Pneumonia was classified as severe or very severe in 83.9% of patients and for 23% as complicated. Global mortality was 1.5%. Hypoxia, diagnosed in 51.5% of children, looked like a better prognosis predictor than the WHO classification.ConclusionNew strategies for health care are necessary, such as the incorporation of peripheral saturometry as the “fifth signal”, investment in vaccine coverage, and the adequacy of hospital infrastructure for assistance of severely affected patients.

Effectiveness of linezolid and imipenem association in the treatment of severe community-acquired pneumonia in children: Two case reports

Two children with severe pneumonia, purulent pleural effusions, and abscess formation unresponsive to appropriate antibiotic therapy recovered promptly after the introduction of linezolid and imipenem association. Linezolid is a new antibiotic with high bioavailability and an outstanding safety profile, synergistic with imipenem, which may deserve a place in the armamentarium for severe pneumonia in children.