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Pneumonia in childhood: etiology and response to antimicrobial therapy
O Ruuskanen1, H Nohynek, T Ziegler
1Department of Pediatrics, Turku University Hospital, Finland.
Abstract:
A prospective eight-month study was carried out in 50 children admitted to hospital for radiologically confirmed community-acquired pneumonia. A potential causative agent of infection was identified in 44 (88%) cases. Using virus isolation, virus antigen detection and enzyme immunoassay serology, respiratory virus infection was diagnosed in 30 (60%) patients. Antibody assays for seven bacteria and antigen detection from serum and urine for Streptococcus pneumoniae produced evidence of bacterial infection in 31 (62%) cases. Streptococcus pneumoniae (38%), respiratory syncytial virus (30%) and Mycoplasma pneumoniae (20%) were the most common causative agents. A mixed infection was diagnosed in 25 (50%) episodes. Nine patients failed to respond to antibiotics within 24 h after onset of treatment. Three of them had a pure viral infection, three a mixed viral-bacterial infection, two a Mycoplasma pneumoniae infection mixed with other bacteria and one a pure Mycoplasma pneumoniae infection. All three Mycoplasma pneumoniae infections were initially treated with penicillin.
Insights
Community-acquired pneumonia in children is often caused by multiple pathogens, including Streptococcus pneumoniae and respiratory viruses. Early diagnosis and appropriate treatment are crucial, especially for Mycoplasma pneumoniae infections.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Community-acquired pneumonia (CAP) is a significant cause of childhood hospitalization.
- Identifying the causative agents of CAP is essential for effective treatment.
Purpose of the Study:
- To investigate the spectrum of infectious agents causing CAP in hospitalized children.
- To evaluate the diagnostic methods for identifying viral and bacterial pathogens.
- To assess treatment responses and identify factors associated with treatment failure.
Main Methods:
- Prospective study of 50 hospitalized children with radiologically confirmed CAP.
- Utilized virus isolation, antigen detection, and enzyme immunoassay serology for viral diagnosis.
- Employed antibody assays and antigen detection for bacterial identification, including Streptococcus pneumoniae.
Main Results:
- Causative agents identified in 88% of cases.
- Respiratory viruses diagnosed in 60% and bacterial infections in 62% of patients.
- Most common agents: Streptococcus pneumoniae (38%), respiratory syncytial virus (30%), Mycoplasma pneumoniae (20%).
- Mixed infections occurred in 50% of episodes.
- Nine patients (18%) showed no response to antibiotics within 24 hours; Mycoplasma pneumoniae was implicated in several non-responsive cases, particularly when treated with penicillin.
Conclusions:
- A significant proportion of pediatric CAP cases involve multiple pathogens.
- Streptococcus pneumoniae, respiratory syncytial virus, and Mycoplasma pneumoniae are key etiological agents.
- Treatment failure may be linked to specific pathogens like Mycoplasma pneumoniae and inappropriate initial antibiotic choices.