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The Contribution of Viruses and Bacteria to Childhood Community-acquired Pneumonia: 11-Year Observational Study From
Anastasios Smyrnaios1,2, Kari Risnes1,2, Sidsel Krokstad3
1From the Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Insights
Respiratory syncytial virus (RSV), human metapneumovirus (HMPV), and Mycoplasma pneumoniae are key drivers of pediatric community-acquired pneumonia (CAP). Higher viral loads of RSV and HMPV correlate with increased CAP risk.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Medicine
- Microbiology
Background:
- Community-acquired pneumonia (CAP) in children is often linked to viruses, which are also prevalent in healthy children's upper airways.
- Distinguishing the specific contribution of respiratory viruses and bacteria to pediatric CAP is crucial for understanding disease etiology.
Purpose of the Study:
- To determine the etiological role of respiratory viruses and bacteria in pediatric CAP.
- To compare the prevalence of pathogens in children with CAP versus healthy controls.
Main Methods:
- A case-control study involving 715 children with radiologically confirmed CAP and 673 hospital controls admitted for elective surgery.
- Nasopharyngeal aspirates were analyzed using polymerase chain reaction (PCR) for 20 respiratory pathogens and cultured for bacteria and viruses.
- Logistic regression analysis was used to calculate adjusted odds ratios (aOR) and population-attributable fractions (PAFs).
Main Results:
- At least one virus was detected in 85% of CAP cases and 76% of controls; bacteria were detected in 70% of both groups.
- Respiratory syncytial virus (RSV) (aOR 16.6), human metapneumovirus (HMPV) (aOR 13.0), and Mycoplasma pneumoniae (aOR 27.7) showed the strongest association with CAP.
- Higher viral genomic loads (lower cycle threshold values) of RSV and HMPV correlated with increased odds of CAP.
Conclusions:
- RSV, HMPV, and M. pneumoniae are significantly associated with pediatric CAP, collectively accounting for approximately half of all cases.
- A positive trend exists between increasing viral loads of RSV and HMPV and higher odds of developing CAP.
- These findings highlight the critical role of specific viruses and M. pneumoniae in the pathogenesis of pediatric CAP.
Background:
Viruses are associated with pediatric community-acquired pneumonia (CAP) but are also common in the upper airways of healthy children. We have determined the contribution of respiratory viruses and bacteria by comparing children with CAP and hospital controls.
Methods:
Children less than 16 years old with radiologically confirmed CAP (n = 715) were enrolled over an 11-year period. Children admitted for elective surgery during the same period served as controls (n = 673). Nasopharyngeal aspirates were tested for 20 respiratory pathogens by semiquantitative polymerase chain reaction tests and cultivated for bacteria and viruses. We used logistic regression to calculate adjusted odds ratios [aOR; 95% confidence intervals (CIs)], and estimated population-attributable fractions (95% CI).
Results:
At least 1 virus was detected in 85% of cases and 76% of controls, and greater than or equal to 1 bacterium was detected in 70% of cases and controls. The presence of respiratory syncytial virus (RSV) (aOR, 16.6; 95% CI: 9.81-28.2), human metapneumovirus (HMPV) (13.0; 6.17-27.5) and Mycoplasma pneumoniae (27.7; 8.37-91.6) were most strongly associated with CAP. For RSV and HMPV, there were significant trends between lower cycle-threshold values indicating higher viral genomic loads, and higher aORs for CAP. The population-attributable fraction estimates of RSV, HMPV, human parainfluenza virus, influenza virus and M. pneumoniae were 33.3% (32.2-34.5), 11.2% (10.5-11.9), 3.7% (1.0-6.3), 2.3% (1.0-3.6) and 4.2% (4.1-4.4), respectively.
Conclusions:
RSV, HMPV and M. pneumoniae were most strongly related to pediatric CAP and accounted for half of all cases. There were positive trends between increasing viral genomic loads of RSV and HMPV, and higher odds for CAP.
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