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Acute lower respiratory tract infections in children in Kuwait
Z Hijazi1, A Pacsa, F el-Gharbawy
1Department of Paediatrics, Mubarak Al-Kabeer Hospital, Faculty of Medicine, Kuwait University, Safat, Kuwait.
Insights
This study describes community-acquired acute lower respiratory tract infections in children. Respiratory syncytial virus was common, but key clinical signs and simple tests can help identify bacterial pneumonia in resource-limited settings.
Area of Science:
- Pediatrics
- Infectious Diseases
- Respiratory Medicine
Background:
- Community-acquired acute lower respiratory tract infections (ALRIs) are a significant cause of childhood morbidity.
- Distinguishing between viral and bacterial pneumonia is crucial for appropriate treatment, especially in resource-limited areas.
Purpose of the Study:
- To describe the clinical features of ALRIs in children.
- To identify indicators that differentiate bacterial from viral pneumonia.
Main Methods:
- Retrospective analysis of 390 children with ALRIs.
- Clinical data collection including symptoms, physical examination findings, and laboratory results.
- Microbiological investigations including blood cultures and viral assays.
Main Results:
- Bronchiolitis (50%), pneumonia (37%), and croup (13%) were the main diagnoses.
- Respiratory syncytial virus was the most frequent pathogen.
- Bacterial pneumonia was associated with high fever (>39°C), toxic appearance, bronchial breathing, elevated white cell count (WCC), neutrophil count, platelet count, ESR, lobar consolidation, and pleural effusion.
Conclusions:
- Clinical signs like high fever, toxic appearance, and bronchial breathing, along with basic laboratory tests, can aid in identifying bacterial pneumonia in children.
- These indicators are particularly valuable in resource-limited settings for guiding clinical decisions.
Abstract:
The features of community-acquired acute lower respiratory tract infections in 390 children are described. Half (50%) presented with bronchiolitis, 37% with pneumonia and 13% with croup. Respiratory syncytial virus was the commonest agent identified (52% of bronchiolitis, 29% of pneumonia, 51% of croup). Positive bacterial blood cultures were obtained in 10% of the patients, all except one with pneumonia. Fever (> 39 degrees C), a toxic ill look, bronchial breathing, WCC > 20 x 10(9)/l, neutrophils > 5 x 10(9)/l, platelet count > 500 x 10(9)/l, ESR > 45 mm/hr, lobar consolidation and pleural effusion were more likely to be associated with bacterial than with viral pneumonia (relative risk > 1.81; p < 0.05). In areas with limited resources, a high fever, a toxic ill look, bronchial breathing and simple laboratory tests may help to identify patients with bacterial pneumonia.