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Infection by Streptococcus pneumoniae in children with or without radiologically confirmed pneumonia
Dafne C Andrade1, Igor C Borges1, Ana Luísa Vilas-Boas1
1Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Salvador, BA, Brazil.
Objective:
Community-acquired pneumonia is an important cause of morbidity in childhood, but the detection of its causative agent remains a diagnostic challenge. The authors aimed to evaluate the role of the chest radiograph to identify cases of community-aquired pneumonia caused by typical bacteria.
Methods:
The frequency of infection by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis was compared in non-hospitalized children with clinical diagnosis of community acquired pneumonia aged 2-59 months with or without radiological confirmation (n=249 and 366, respectively). Infection by S. pneumoniae was diagnosed by the detection of a serological response against at least one of eight pneumococcal proteins (defined as an increase ≥2-fold in the IgG levels against Ply, CbpA, PspA1 and PspA2, PhtD, StkP-C, and PcsB-N, or an increase ≥1.5-fold against PcpA). Infection by H. influenzae and M. catarrhalis was defined as an increase ≥2-fold on the levels of microbe-specific IgG.
Results:
Children with radiologically confirmed pneumonia had higher rates of infection by S. pneumoniae. The presence of pneumococcal infection increased the odds of having radiologically confirmed pneumonia by 2.8 times (95% CI: 1.8-4.3). The negative predictive value of the normal chest radiograph for infection by S. pneumoniae was 86.3% (95% CI: 82.4-89.7%). There was no difference on the rates of infection by H. influenzae and M. catarrhalis between children with community-acquired pneumonia with and without radiological confirmation.
Conclusions:
Among children with clinical diagnosis of community-acquired pneumonia submitted to chest radiograph, those with radiologically confirmed pneumonia present a higher rate of infection by S. pneumoniae when compared with those with a normal chest radiograph.
Insights
Chest X-rays help identify bacterial pneumonia in children. Radiologically confirmed pneumonia is linked to higher rates of Streptococcus pneumoniae infection, unlike other typical bacteria.
Area of Science:
- Pediatric Infectious Diseases
- Diagnostic Imaging in Children
- Microbiology and Immunology
Background:
- Community-acquired pneumonia (CAP) is a significant cause of childhood illness.
- Accurate identification of bacterial pathogens in pediatric CAP is diagnostically challenging.
- Chest radiography plays a role in diagnosing pneumonia but its utility in identifying specific bacterial causes needs evaluation.
Purpose of the Study:
- To assess the effectiveness of chest radiography in identifying community-acquired pneumonia caused by typical bacterial pathogens in children.
- To compare the frequency of infection by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in children with and without radiological confirmation of pneumonia.
Main Methods:
- A comparative study involving non-hospitalized children aged 2-59 months with clinically diagnosed CAP.
- Participants were divided into groups with (n=249) and without (n=366) radiological confirmation of pneumonia.
- Bacterial infection was diagnosed using serological responses to specific bacterial antigens, including pneumococcal proteins and microbe-specific IgG levels.
Main Results:
- Children with radiologically confirmed pneumonia showed significantly higher rates of infection with Streptococcus pneumoniae.
- Pneumococcal infection increased the likelihood of radiologically confirmed pneumonia by 2.8 times.
- No significant difference in infection rates for Haemophilus influenzae and Moraxella catarrhalis was observed between the groups.
Conclusions:
- Radiologically confirmed pneumonia in children is associated with a higher prevalence of Streptococcus pneumoniae infection compared to cases without radiological findings.
- Chest radiography can aid in identifying cases of pediatric CAP more likely caused by S. pneumoniae.
- The role of chest X-ray in identifying H. influenzae and M. catarrhalis in pediatric CAP is not supported by this study.
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