Molecular diagnostic of complicated pneumonia in the post-vaccine era. (13th October 2022)

• Record Type: Journal Article
• Authors: de Vasconcelos, Mariana Galvão Gurgel Cabral; Jarovsky, Daniel; Nunes, Gabriela Zembruski; Tridente, Daniela Marinho; Grill, Juliana Amorim Teixeira; Berezin, Eitan Naaman
• Is Part Of: Journal of tropical pediatrics. Volume 68:Number 6(2022)
• Publication Date: 2022-10-13
• Subjects: community-acquired pneumonia -- CAP -- complicated pneumonia -- multiplex real-time PCR -- Streptococcus pneumoniae; Pediatrics -- Periodicals; Tropical medicine -- Periodicals; Pediatrics -- Periodicals; Tropical Medicine -- Periodicals; Environmental Health -- Periodicals; Infant; Child; 618.929883
• DOI: 10.1093/tropej/fmac086
• Languages: English
• ISSNs: 0142-6338

Abstract

SUMMARY: Background: The etiological diagnosis of community-acquired pneumonia (CAP) is still a challenge. We compared the conventional culture method and real-time polymerase chain reaction (RT-PCR) for the identification of Streptococcus pneumoniae in severe pediatric CAP. Methods: A retrospective hospital-based study was conducted. From 2012 to 2018, we have selected patients who had peripheral blood and/or pleural fluid collected for etiological investigation by RT-PCR. Results: We included 113 children (median age: 3 years; interquartile range 1–6 years). RT-PCR increased the detection rate of S. pneumoniae by 6.5 times using blood samples and eight times using pleural fluid samples. Patients subjected to RT-PCR showed more prolonged hospitalization ( p = 0.006), fewer comorbidities ( p = 0.03), presence of pleural effusion ( p = 0.001), presence of young forms of leukocytes ( p = 0.001) and radiograph with characteristics of pneumonia ( p = 0.002). The presence of pleural effusion [odds ratio (OR) = 14.7, 95% confidence interval (CI) 1.6–133.9; p = 0.01] and young forms of leukocytes (OR = 8.9, 95% CI 0.9–84.4; p = 0.05) were risk factors for positive RT-PCR pneumococcal when multivariate analysis was performed. Conclusions: RT-PCR is a reliable method for diagnosing severe CAP using sterile materials and a potentially applicable method in patients with clinical, radiological and non-specific laboratory characteristics of lower respiratory tract infection, especially in complicated cases with pleural effusion.