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Wheezing independently predicts viral infection in children with community-acquired pneumonia

Amanda C Nascimento-Carvalho1, Olli Ruuskanen2, Cristiana M Nascimento-Carvalho3

  • 1Bahiana School of Medicine, Bahiana Foundation for Science Development, Salvador, Brazil.

Pediatric Pulmonology
|April 21, 2019
PubMed

Insights

Wheezing on physical examination is a strong indicator of viral infection in children with community-acquired pneumonia. This finding helps differentiate between viral and bacterial causes in pediatric patients.

Area of Science:

  • Pediatric Infectious Diseases
  • Respiratory Medicine
  • Clinical Microbiology

Background:

  • Community-acquired pneumonia (CAP) is a common childhood illness with varied etiologies.
  • Differentiating between viral and bacterial CAP is crucial for appropriate treatment and management.
  • Previous studies have explored clinical differences, but specific predictors require further investigation.

Purpose of the Study:

  • To compare the frequency of symptoms and signs in children hospitalized with CAP based on viral or bacterial infection.
  • To identify clinical predictors that can help distinguish between viral and bacterial etiologies of CAP in young children.

Main Methods:

  • A prospective cross-sectional study included 188 children under 5 years old hospitalized with CAP in Salvador, Brazil.
  • Etiological diagnosis involved investigating 11 viruses and 8 bacteria using methods like blood culture, DNA detection, and serological tests.
  • Infection types were categorized as only viral, mixed viral-bacterial, or only bacterial.

Main Results:

  • Viral infection was identified in 51.6%, mixed in 30.9%, and bacterial in 17.5% of cases.
  • Wheezing (reported and auscultated) and rhonchi were significantly more frequent in children with viral CAP.
  • Auscultated wheezing was an independent predictor of viral infection (AdjOR: 9.6), also associated with asthma and younger age.

Conclusions:

  • Wheezing detected on physical examination is a significant independent predictor of viral infection in pediatric CAP.
  • This clinical sign demonstrates a high positive predictive value (96.3%) for identifying viral etiologies.
  • Findings aid in the clinical differentiation of viral versus bacterial pneumonia in children, guiding diagnostic and therapeutic strategies.
Abstract

Keywords:
acute respiratory infectionlower respiratory tract infectionlung diseaserespiratory viruseswheeze

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