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Etiology of childhood pneumonia: serologic results of a prospective, population-based study
T Heiskanen-Kosma1, M Korppi, C Jokinen
1Department of Pediatrics, Kuopio University Hospital, Finland. heiskane@messi.uku.fi
Insights
Streptococcus pneumoniae is the leading cause of pediatric community-acquired pneumonia. Mycoplasma pneumoniae and Chlamydia pneumoniae are significant in older children, highlighting age-specific etiologies.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Medicine
- Microbiology
Background:
- Investigated the etiology of pediatric community-acquired pneumonia (CAP) in a population-based cohort.
- Study included 8851 children under 15 years in eastern Finland.
Purpose of the Study:
- To determine the causative agents of pediatric CAP.
- To analyze the age-specific distribution of identified pathogens.
Main Methods:
- Prospective study of 201 pediatric CAP cases.
- Utilized serologic assays for bacterial (Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia spp.), and viral (respiratory syncytial virus) infections.
- Chest radiographs and paired sera were analyzed.
Main Results:
- Identified a specific microbial etiology in 66% of cases.
- Streptococcus pneumoniae was the most common bacterial cause (28%).
- Mycoplasma pneumoniae (22%), RSV (21%), and Chlamydia spp. (14%) were also significant; coinfections occurred in 25%.
Conclusions:
- S. pneumoniae is a primary cause of pediatric CAP across all age groups.
- M. pneumoniae and Chlamydia pneumoniae are important etiologies in children aged 5 years and older.
Background:
To investigate the etiology of pediatric community-acquired pneumonia, we conducted a prospective, population-based study covering the total population <15 years of age (n = 8851) in 4 municipalities in eastern Finland.
Materials And Methods:
The number of patients was 201; chest radiographs were available for all cases and paired sera for serologic assays were available for >90% of cases. The methods included assays for antibody response to 3 pneumococcal antigens, specific pneumococcal immune complex assays and conventional antibody tests for mycoplasmal, chlamydial and viral infections.
Results:
Serologic evidence of specific microbial etiology was obtained in 133 (66%) of the pneumonia patients. Bacterial infection was diagnosed in 102 cases (51%) and viral infection in 51 cases (25%). Streptococcus pneumoniae was the most common agent (57 cases; 28%), followed by Mycoplasma pneumoniae (44; 22%), respiratory syncytial virus (43; 21%) and Chlamydia spp. (29; 14%). Haemophilus influenzae was identified in only 6% and Moraxella catarrhalis in only 3% of the children. More than one specific infection was found in 51 patients (25%). The proportion of pneumococcal cases varied from 24 to 36% by age. Mycoplasma infections were seen mostly in patients > or =5 years and Chlamydia infections in patients > or =10 years of age.
Conclusions:
The results of our prospective, strictly population-based study confirm the importance of S. pneumoniae in the etiology of community-acquired pneumonia in children of all ages. M. pneumoniae and Chlamydia pneumoniae are important from the age of 5 years onwards.