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Pediatric pneumonia - A clinico-pathological study
Pragati A Sathe1, Monalisa Dash1, Pradeep Vaideeswar1
1Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
Insights
Autopsy revealed varied causes of pediatric pneumonia, with viral and bacterial patterns being most common. Clinical data often failed to distinguish between viral and bacterial pneumonia in children.
Area of Science:
- Pediatric Pathology
- Infectious Diseases
- Pulmonology
Background:
- Childhood pneumonia stems from diverse pathogens like bacteria, viruses, and fungi.
- Clinical symptoms of viral and bacterial pneumonia often overlap, complicating diagnosis.
- Despite viruses being more common, antibiotics are frequently the initial treatment for pediatric pneumonia.
Purpose of the Study:
- To detail pulmonary histopathological patterns in pediatric pneumonia cases (<12 years) via autopsy.
- To identify the likely causes of pneumonia and correlate them with clinical presentations.
- To provide insights into pneumonia pathogenesis and antibiotic use in children.
Main Methods:
- A 3-year retrospective, single-center autopsy study.
- Correlation of clinical data with postmortem histopathological findings.
- Etiological classification into viral, bacterial, mixed, or other categories.
Main Results:
- Pneumonia was diagnosed postmortem in 34% (89/262) of autopsied children.
- Histological patterns suggested viral etiology in 51.7% (46/89) and bacterial in 30.3% (27/89) of cases.
- Antibiotics were administered to 35/46 patients with viral patterns and 4/89 with other diagnoses like tuberculosis and invasive aspergillosis.
Conclusions:
- Clinical features and investigations are unreliable for differentiating viral from bacterial pneumonia in children.
- Autopsy is crucial for understanding pneumonia pathogenesis and identifying inappropriate antibiotic use.
- This study highlights a gap in Indian research comparing clinical and postmortem pneumonia findings in pediatric cases.
Context:
Numerous pathogens (bacteria, viruses, or fungi) can cause childhood pneumonia. The clinical presentations of viral and bacterial pneumonia can be similar. Though viruses are a more common cause as compared to bacteria, antibiotics remain the first line of treatment for pneumonia.
Aims:
This study was planned to describe the pulmonary histopathological patterns in cases of pediatric pneumonia (age <12 years) at autopsy and aimed to identify the probable etiology and correlate with clinical presentations.
Materials And Methods:
This is a single-center 3-year retrospective descriptive autopsy study. Relevant clinical data was correlated with the postmortem findings. The cases were assigned to one of the following categories based on probable etiology: viral, bacterial, mixed, or others.
Results:
There were 89 cases with a postmortem diagnosis of pneumonia among 262 autopsied children (34%). Most patients had histological patterns that suggested viral and bacterial etiology in 46 (51.7%) and 27 (30.3%), respectively. A total of 35 out of 46 patients received antibiotics. Twelve cases had mixed viral and bacterial patterns. Antibiotics were also given in the remaining four children (4.5%) with a similar clinical presentation, where a diagnosis of tuberculosis (03 cases) and invasive aspergillosis (01) was made at autopsy.
Conclusion:
Neither clinical features nor investigations reliably differentiate between viral and bacterial pneumonia. Autopsy has an important role in providing insights into the pathogenesis of pneumonia and suggests inappropriate antibiotic exposure. No prior Indian studies have been performed to compare the clinical and postmortem findings of pneumonia in children.
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