Association Between Bacterial Infection and Radiologically Confirmed Pneumonia Among Children. Issue 5 (May 2015)

• Record Type: Journal Article
• Authors: Nascimento-Carvalho, Cristiana M.; Araújo-Neto, César A.; Ruuskanen, Olli
• Is Part Of: Pediatric infectious disease journal. Volume 34:Issue 5(2015)
• Publication Date: 2015-05
• Subjects: acute respiratory infection -- child -- lower respiratory tract infection -- lung disease -- pneumonia radiography; Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000000622
• Languages: English
• ISSNs: 0891-3668

Abstract

Abstract : Background: The role of chest radiograph (CXR) among children with community-acquired pneumonia is controversial. We aimed to assess if there is association between a specific etiology and radiologically confirmed pneumonia. Methods: This was a prospective cross-sectional study. Based on report of respiratory complaints and fever/difficulty breathing plus the detection of pulmonary infiltrate/pleural effusion on the CXR taken upon admission read by the pediatrician on duty, children <5-year-old hospitalized with community-acquired pneumonia were enrolled. On admission, clinical data and biological samples were collected to investigate 19 etiological agents (11 viruses and 8 bacteria). CXR taken upon admission was independently read by a pediatric radiologist blinded to clinical data. Results: The study group comprised 209 cases with evaluated CXR and establishment of a probable etiology. Radiologically confirmed pneumonia, normal CXR and other radiographic diagnoses were described for 165 (79.0%), 36 (17.2%) and 8 (3.8%) patients, respectively. Viral infection was significantly more common among patients without radiologically confirmed pneumonia (68.2% vs. 47.9%; P = 0.02), particularly among those with normal CXR (66.7% vs. 47.9%; P = 0.04) when compared with patients with radiologically confirmed pneumonia. Bacterial infection was more frequent among cases with radiologically confirmed pneumonia (52.1% vs. 31.8%; P = 0.02). Likewise, pneumococcal infection was more frequently detected among children with radiologically confirmed pneumonia in regard to children with normal CXR (24.2% vs. 8.3%; P = 0.04). Sensitivity (95% confidence interval) of radiologically confirmed pneumonia for pneumococcal infection was 93% (80–98%), and negative predictive value (95% confidence interval) of normal CXR for pneumococcal infection was 92% (77–98%). Conclusion: Bacterial infection, especially pneumococcal one, is associated with radiologically confirmed pneumonia. Abstract : Supplemental Digital Content is available in the text.